Clinical efficacy of osimertinib in EGFR-mutant non-small cell lung cancer with distant metastasis

BMC Cancer. 2022 Jun 14;22(1):654. doi: 10.1186/s12885-022-09741-8.

Abstract

Background: Osimertinib-the third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI)-has been widely used as a first-line treatment for patients with metastatic EGFR-mutant non-small cell lung cancer (NSCLC). Osimertinib demonstrated central nervous system activity in patients with brain metastasis; however, its efficacy against other distant metastatic organs, including bone and liver, remains unclear. Therefore, we retrospectively analyzed the clinical efficacy of osimertinib in these patients in comparison to other EGFR-TKIs.

Methods: Clinical data of patients with advanced NSCLC receiving gefitinib/erlotinib (n = 183), afatinib (n = 55), or osimertinib (n = 150) at five medical institutions were retrospectively assessed for progression-free survival (PFS), overall survival (OS), and best overall response rate (ORR).

Results: In univariate and multivariate analyses, most distant metastases, including the brain and bone, were unrelated to the therapeutic efficacy of osimertinib, although liver metastasis and L858R mutation were independently associated with shorter PFS. PFS and OS in patients with liver metastases were significantly shorter than those in patients without liver metastases (PFS: 7.4 vs. 19.7 months, OS: 12.1 months vs. not reached, respectively). Osimertinib provided significantly longer PFS in patients with brain or bone metastasis and exon 19 deletion than the other EGFR-TKIs. The PFS of patients with liver metastases was not significantly different among the three EGFR-TKI groups. Furthermore, the ORR of osimertinib in patients with liver metastases was significantly attenuated, and the effectiveness was similar to 1st- or 2nd -generation EGFR-TKIs.

Conclusion: Osimertinib provided better clinical benefits than 1st- and 2nd-generation EGFR-TKIs for patients with EGFR-mutant NSCLC, particularly those with brain or bone metastases and exon 19 deletion; however, its efficacy against liver metastasis was remarkably attenuated. New therapeutic developments for patients with EGFR-mutant NSCLC with liver metastases are needed.

Keywords: Distant metastases; EGFR mutation; EGFR-TKIs; Non-small cell lung cancer; Osimertinib.

MeSH terms

  • Acrylamides
  • Aniline Compounds / pharmacology
  • Aniline Compounds / therapeutic use
  • Carcinoma, Non-Small-Cell Lung* / drug therapy
  • Carcinoma, Non-Small-Cell Lung* / genetics
  • Carcinoma, Non-Small-Cell Lung* / pathology
  • ErbB Receptors
  • Humans
  • Indoles
  • Liver Neoplasms* / chemically induced
  • Liver Neoplasms* / drug therapy
  • Liver Neoplasms* / genetics
  • Lung Neoplasms* / drug therapy
  • Lung Neoplasms* / genetics
  • Lung Neoplasms* / pathology
  • Mutation
  • Neoplasm Metastasis
  • Protein Kinase Inhibitors / pharmacology
  • Pyrimidines
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Acrylamides
  • Aniline Compounds
  • Indoles
  • Protein Kinase Inhibitors
  • Pyrimidines
  • osimertinib
  • EGFR protein, human
  • ErbB Receptors