Clinical outcomes in patients with advanced epidermal growth factor receptor-mutated non-small-cell lung cancer in South Western Sydney Local Health District

Pei N Ding; Tara L Roberts; Wei Chua; Therese M Becker; Joseph Descallar; Po Y Yip; Victoria Bray

doi:10.1111/imj.13555

Clinical outcomes in patients with advanced epidermal growth factor receptor-mutated non-small-cell lung cancer in South Western Sydney Local Health District

Intern Med J. 2017 Dec;47(12):1405-1411. doi: 10.1111/imj.13555.

Authors

Pei N Ding^{1

2

3}, Tara L Roberts^{1

3

4}, Wei Chua^{2

4}, Therese M Becker^{1

3

4}, Joseph Descallar^{1

4}, Po Y Yip^{3

5}, Victoria Bray^{2

4}

Affiliations

¹ Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.
² Medical Oncology Department, Liverpool Hospital, Sydney, New South Wales, Australia.
³ School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
⁴ South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
⁵ Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia.

PMID: 28742280
DOI: 10.1111/imj.13555

Abstract

Background: Epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) is a subgroup of oncogene addicted lung cancer that predicts response to tyrosine kinase inhibitors (TKI). However, there is variability in response and survival outcomes in patients with EGFR mutation treated with TKI.

Aim: To describe clinical characteristics, treatment patterns and factors influencing outcomes in patients with EGFR-mutated NSCLC in South Western Sydney Local Health District.

Methods: Retrospective review of patients with EGFR-mutated NSCLC diagnosed between January 2010 and June 2016.

Results: A total of 85 EGFR-mutated NSCLC patients was identified; 80 (94%) received first-line treatment with EGFR-TKI. The median follow-up was 10.7 months with a median duration of treatment of 9 months. On disease progression (n = 44), 37% had best supportive care only, 30% received chemotherapy, 23% participated in clinical trials, 7% continued on a first generation EGFR-TKI and 3% received afatinib. Overall response rate to first-line EGFR-TKI was 66%. Median progression-free survival (PFS) was 10.7 months (range 2.7-55.9 months) and median overall survival (OS) was 23 months (range 0.4-35.8 months). Multivariate Cox regression analysis showed that patients with lower disease burden (<4 sites) had longer PFS (hazard ratio (HR) 0.36, 95% confidence interval (CI) 0.18-0.72, P = 0.004) but not OS. Good performance status predicts longer OS (HR 0.33, CI 0.14-0.77, P = 0.01). Lower (<5) pre-treatment neutrophil-to-lymphocyte ratio (NLR) was associated with better PFS (HR 0.40, 95% CI 0.18-0.87, P = 0.02) and OS (HR 0.43, 95% CI 0.19-0.94, P = 0.04). There were no survival differences when patients were stratified by age, baseline albumin level and types of EGFR mutation.

Conclusion: Results from this community-based cohort confirm known prognostic factors in patients with EGFR-mutated NSCLC receiving TKI and suggest the negative influence of a heightened host systemic inflammatory response on patient outcomes.

Keywords: epidermal growth factor receptor; non-small-cell lung cancer; prognostic factors; survival; tyrosine kinase inhibitors.

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung / epidemiology*
Carcinoma, Non-Small-Cell Lung / genetics*
Carcinoma, Non-Small-Cell Lung / therapy
Community Health Planning / methods
Community Health Planning / trends
Disease Progression
ErbB Receptors / genetics*
Female
Follow-Up Studies
Humans
Lung Neoplasms / epidemiology*
Lung Neoplasms / genetics*
Lung Neoplasms / therapy
Male
Middle Aged
Mutation / genetics*
New South Wales / epidemiology
Retrospective Studies
Treatment Outcome

Substances

EGFR protein, human
ErbB Receptors