Primary tumor consolidative therapy improves the outcomes of patients with advanced <i>EGFR</i>-mutant lung adenocarcinoma treated with first-line osimertinib-Reference-Cited by-同舟云学术

Primary tumor consolidative therapy improves the outcomes of patients with advanced EGFR-mutant lung adenocarcinoma treated with first-line osimertinib

Published:2024-01 Issue: Volume:16 Page:
ISSN:1758-8359
Container-title:Therapeutic Advances in Medical Oncology
language:en
Short-container-title:Ther Adv Med Oncol

Author:

Wu Jia-Jun¹²³^ORCID,Tseng Jeng-Sen⁴⁵⁶⁷,Zheng Zhe-Rong¹²³,Chu Cheng-Hsiang¹²³^ORCID,Chen Kun-Chieh¹²³,Lin Mong-Wei⁸,Huang Yen-Hsiang⁴⁷,Hsu Kuo-Hsuan⁹^ORCID,Yang Tsung-Ying⁴¹⁰,Yu Sung-Liang¹¹¹²,Chen Jin-Shing¹³¹⁴,Ho Chao-Chi¹⁵,Chang Gee-Chen¹²¹⁶⁶^ORCID

Affiliation:

1. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

2. School of Medicine, Chung Shan Medical University, Taichung, Taiwan

3. Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan

4. Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

5. Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan

6. Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan

7. College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

8. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

9. Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

10. Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan

11. Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan

12. Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan

13. Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan

14. Department of Surgical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan

15. Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan

16. Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Chien-kuo North Road, Taichung 402, Taiwan

Abstract

Background: Patients with advanced epidermal growth factor receptor ( EGFR)-mutant lung adenocarcinoma (LAD) inevitably experience drug resistance following treatment with EGFR-tyrosine kinase inhibitors (TKIs). Objectives: We aimed to analyze the effect of primary tumor consolidative therapy (PTCT) on patients treated with first-line osimertinib. Design and methods: This retrospective cohort study was conducted in patients with advanced stage III or stage IV LAD with EGFR-sensitizing mutations (exon 19 deletion or L858R mutation) with disease control after first-line osimertinib. A curative dose of primary tumor radiotherapy or primary tumor resection was classified as PTCT. We compared the progression-free survival (PFS) and overall survival (OS) of patients with and without PTCT. Results: This study included 106 patients with a median age of 61.0 years, and of those, 42% were male and 73.6% were never-smokers. Exon 19 deletion was observed in 67.9%, 30.2% had a programmed cell death ligand 1 (PD-L1) tumor proportion score <1%, 33.0% had brain metastasis, and 40.6% had oligometastasis. In all, 53 (50%) patients underwent PTCT. Patients who underwent PTCT demonstrated significantly better PFS [30.3 (95% confidence interval (CI), 24.1–36.4) versus 18.2 (95% CI, 16.1–20.2) months; p = 0.005] and OS [not reached versus 36.7 (95% CI, 32.5–40.9) months; p = 0.005] than patients who did not. A multivariate analysis showed that PTCT was an independent factor associated with better PFS [hazard ratio (HR), 0.22; 95% CI, 0.10–0.49; p < 0.001] and OS [HR, 0.10; 95% CI, 0.01–0.82; p = 0.032]. The PFS benefits of PTCT were consistent across subgroups, and the HR tended to be lower in patients aged <65 years, males, smokers, stage IVB disease, L858R, PD-L1 expression ⩾1%, non-oligometastasis, and brain metastasis. Conclusion: Of the patients with advanced EGFR-mutant LAD, those who underwent PTCT had a significantly better survival outcome than those who did not. The survival benefits were consistent across different subgroups.

Funder

National Science and Technology Council

Publisher

SAGE Publications

Link

http://journals.sagepub.com/doi/pdf/10.1177/17588359231220606

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