Early Data Suggest Primary Tumor Resection Following EGFR TKI Treatment May Help Delay Disease Progression in Metastatic NSCLC

*November 2025*

While several phase II studies have demonstrated that local consolidation therapy (LCT) can improve event-free survival outcomes compared to systemic therapy alone, none have specifically evaluated primary tumor resection (PTR) in combination with EGFR TKI therapy before disease progression.

Researchers evaluated whether PTR as LCT in metastatic non-small cell lung cancer (NSCLC) could improve outcomes beyond those achieved with EGFR TKI monotherapy. The results from the randomized phase

The two-arm, phase II PTR-1 trial enrolled 91 patients with EGFR-mutation (+) advanced NSCLC, including both oligometastatic and polymetastatic populations. Dr. Chen said the trial is the first of its kind to evaluate primary tumor resection specifically as local consolidation therapy alongside EGFR TKI in both oligometastatic and polymetastatic NSCLC.

II PTR-1 trial were presented by Pei-Hsing Chen, MD, in September at the 2025 World Conference on Lung Cancer (WCLC) in Barcelona.

Nineteen participants were excluded for either not meeting eligibility requirements or declining to participate. Following 12 weeks of afatinib, 72 participants were randomized (1:1) to either continue afatinib monotherapy or to afatinib and surgery to remove the primary tumor. Radiotherapy was allowed for non-pulmonary lesions. The majority of participants were women and individuals with no previous tobacco smoking history.

Dr. Chen said all patients on the surgery arm underwent minimally invasive resections following EGFR TKI treatment, with few surgical complications and no surgery-related mortality. The median time from drug to surgery was 3.7 months in the TKI-plus-PTR arm.

The primary endpoint was 2-year progression-free survival (PFS); secondary endpoints included overall PFS and overall survival (OS). Postoperative specimens were assessed for pathological response and molecular profiling in patients with sufficient residual tumor tissue.

The PFS hazard ratio (HR) was 0.48, though data remain immature, Dr. Chen said. Major pathological response (MPR) was observed in 29.4% of the PTR arm, and pathological complete response (pCR) was observed in 5.9%.

In the TKI-plus-PTR group, exon 19 deletion was associated with a higher pathological response rate in the primary tumor than L858R. However, the L858R subgroup showed a lower HR for PFS (0.38) than the exon 19 deletion subgroup (0.60).

Major pathological response has not yet correlated with improved survival, he added. Read more.