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Characteristics of Long-Term Survivors with EGFR Mutant Metastatic NSCLC

*March 2024*

Abstract

Introduction

Characteristics of long-term survivors in EGFRm NSCLC are not fully understood. This retrospective analysis evaluated a multi-institution cohort of patients with EGFRm NSCLC treated in the pre-osimertinib era and sought to describe characteristics of long-term survivors.

Methods

Clinical characteristics and outcomes were abstracted from the electronic medical records of patients with EGFRm mNSCLC who started first-line therapy before 2015. Demographics and comutations were compared between ≥5 year survivors and <5 year survivors. Multivariable Cox PH and logistic regression models were used to evaluate factors associated with survival and the odds of death within 5 years, respectively.

Results

133 patients were ≥5-year survivors; 127 were <5-year survivors. Burden of pathogenic comutations including TP53 and PIK3CA was similar between ≥5-year survivors and <5-year survivors. Receipt of first-line chemotherapy rather than EGFR-TKI was similar between the groups (22% of <5-year vs 31% of ≥5-year). Baseline brain metastasis and history of smoking were associated with higher odds of death within 5 years (OR=2.16, p=0.029 and OR=1.90, p=0.046, respectively). Among patients without baseline brain metastases, cumulative incidence of brain metastases at 5 years was 42.3%. Both baseline and post-baseline brain metastasis were associated with worse OS compared to no brain metastasis (HR=3.26, p<0.001 and HR=4.99, p<0.001, respectively).

Conclusions

Within patients treated for EGFRm mNSCLC prior to 2015, absence of brain metastasis and nonsmoking status were predictive of 5-year survival. Our findings help to define a subset of patients with EGFRm NSCLC with excellent survival outcomes who may not require intensification of initial therapy. Read more.