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Updates in EGFR-Mutated Oligometastatic NSCLC

*June 2023*

In Hollywood, the word “mutant” generally has a negative connotation, with movie plot lines that involve rogue mutants, mercenary mutants, or hunted mutants. But in the lung cancer space, harboring an EGFR mutation may confer an advantage.

In a study that sought to pinpoint survival outcomes for patients with synchronous oligometastatic non-small-cell lung cancer (NSCLC) who got local consolidative therapy (LCT), “EGFR mutations were associated with longer OS [overall survival] among oligometastatic patients treated with comprehensive LCT in addition to systemic therapy,” reported Saumil J. Gandhi, MD, PhD, of the University of Texas MD Anderson Cancer Center (MDACC) in Houston, and colleagues.
They identified patients at MDACC who presented between 2000 and 2017 with stage IV NSCLC and ≤3 synchronous metastatic sites, and then grouped them according to mutational statuses, with almost a fourth harboring EGFR mutations.

Gandhi’s group reported in JCO Precision Oncology that, on multivariable analysis, patients with EGFR mutations had lower mortality risk versus wild-type patients, and that among patients with known EGFR mutational status who received comprehensive LCT, EGFR mutations were linked with lower mortality, again compared with wild-type patients.

“[W]e find through this analysis that patients with EGFR mutations receiving both TKIs [tyrosine kinase inhibitors] and comprehensive LCT had the most favorable outcomes, with a median survival of 98 months, which is longer than that observed for any other mutational subset, and remarkably high, considering these patients all presented with stage IV disease at diagnosis,” the researchers stated.

The study patients underwent a radiotherapy (RT) protocol per a 2021 study by Gandhi and colleagues, and two experts highlighted the role of RT in the LCT setting for EGFR-mutated, and/or oligometastatic NSCLC. Read more.