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Introduction <p>Osimertinib, a third-generation tyrosine kinase inhibitor (TKI), is a standard first-line (1L) treatment for advanced/metastatic <i>EGFR</i> non-small cell lung cancer (NSCLC). Despite improved overall survival (OS) and progression-free survival (PFS) compared to earlier generation TKIs, resistance and disease progression are common. No standardized second-line (2L) treatment exists for patients who progress after 1L osimertinib. This study assessed real-world (rw) treatment patterns and clinical outcomes in French patients with advanced/metastatic NSCLC who received 2L therapy post-osimertinib progression.</p> Methods <p>This retrospective, observational study used the Epidemio-Strategy and Medical Economics (ESME) LC database (NCT03848052) (January 1, 2015–2023; data extraction September 2023). Patients ≥ 18&#xa0;years with confirmed advanced/metastatic NSCLC, treated with 1L osimertinib, and documented 2L therapy were included. The study assessed patient characteristics, rw treatment patterns, rwOS, and rwPFS.</p> Results <p>Among 284 patients (71.1% female, median age 67), 67% initiated 2L treatment in 2021 or later. The median number of metastases at 2L initiation was three, with bone (65.1%) and brain (56.6%) as the most common sites; 34% of brain metastases were symptomatic. The 2L treatments included platinum-based chemotherapy (50%), <i>EGFR</i> TKI-based therapy (29.9%), immunotherapy (9.9%), and other regimens (10.2%). Median rwOS from 2L initiation was 10.1 (95% CI 9.2–12.1)&#xa0;months, and median rwPFS was 4.1 (95% CI 3.3–4.8)&#xa0;months. Among patients with brain metastases, median rwOS was 8.7 (95% CI 7.1–11.9)&#xa0;months for asymptomatic and 10.7 (95% CI 9.4–12.9)&#xa0;months for symptomatic patients vs 11.8 (95% CI 9.1–17.4)&#xa0;months in patients without brain metastases. Patients with liver metastases had a median rwOS of 8.2 (95% CI 6.4–9.6)&#xa0;months vs 12.3 (95% CI 10.2–14.3)&#xa0;months in those without.</p> Conclusions <p>Clinical outcomes for patients receiving 2L therapy post-osimertinib progression remain poor, highlighting an unmet need, particularly for those with brain and liver metastases.</p>

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Real-World Clinical Outcomes and Treatment Patterns in Advanced/Metastatic EGFR-Mutant NSCLC After Progression on First-Line Osimertinib for French Patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月13日

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  • Nicolas Girard,
  • Pauline Macouillard,
  • Danalyn Byng,
  • Jie Meng,
  • Friso Coerts,
  • Shannon Hunter,
  • Alessandria Struebing,
  • Yan Xiong,
  • Sarah Park,
  • M. Inaam Haq,
  • Olga Tymejczyk,
  • Christos Chouaid,
  • Clarisse Audigier-Valette,
  • Didier Debieuvre,
  • Xavier Quantin,
  • Lise Bosquet,
  • Maurice Pérol

摘要

Introduction

Osimertinib, a third-generation tyrosine kinase inhibitor (TKI), is a standard first-line (1L) treatment for advanced/metastatic EGFR non-small cell lung cancer (NSCLC). Despite improved overall survival (OS) and progression-free survival (PFS) compared to earlier generation TKIs, resistance and disease progression are common. No standardized second-line (2L) treatment exists for patients who progress after 1L osimertinib. This study assessed real-world (rw) treatment patterns and clinical outcomes in French patients with advanced/metastatic NSCLC who received 2L therapy post-osimertinib progression.

Methods

This retrospective, observational study used the Epidemio-Strategy and Medical Economics (ESME) LC database (NCT03848052) (January 1, 2015–2023; data extraction September 2023). Patients ≥ 18 years with confirmed advanced/metastatic NSCLC, treated with 1L osimertinib, and documented 2L therapy were included. The study assessed patient characteristics, rw treatment patterns, rwOS, and rwPFS.

Results

Among 284 patients (71.1% female, median age 67), 67% initiated 2L treatment in 2021 or later. The median number of metastases at 2L initiation was three, with bone (65.1%) and brain (56.6%) as the most common sites; 34% of brain metastases were symptomatic. The 2L treatments included platinum-based chemotherapy (50%), EGFR TKI-based therapy (29.9%), immunotherapy (9.9%), and other regimens (10.2%). Median rwOS from 2L initiation was 10.1 (95% CI 9.2–12.1) months, and median rwPFS was 4.1 (95% CI 3.3–4.8) months. Among patients with brain metastases, median rwOS was 8.7 (95% CI 7.1–11.9) months for asymptomatic and 10.7 (95% CI 9.4–12.9) months for symptomatic patients vs 11.8 (95% CI 9.1–17.4) months in patients without brain metastases. Patients with liver metastases had a median rwOS of 8.2 (95% CI 6.4–9.6) months vs 12.3 (95% CI 10.2–14.3) months in those without.

Conclusions

Clinical outcomes for patients receiving 2L therapy post-osimertinib progression remain poor, highlighting an unmet need, particularly for those with brain and liver metastases.