Real-world survival data analysis in EGFR-mutated NSCLC patients.

Abstract

e20697 Background: EGFR tyrosine kinase inhibitors (TKIs) have become the standard first-line treatment for advanced non-small cell lung cancer (NSCLC) patients with EGFR mutations, based on pivotal RCTs such as IPASS and FLAURA. However, these trials primarily included patients with classic EGFR mutations (exon 19 deletions and L858R), while real-world scenarios involve more complex cases, including non-classical mutations, co-mutations, and post-TKI resistance. This study aims to retrospectively analyze the survival outcomes of EGFR-mutated NSCLC patients treated with EGFR TKIs at Shanxi Provincial Cancer Hospital over five years, focusing on progression-free survival (PFS) and overall survival (OS) across different mutation types and treatment patterns. Methods: This real-world, retrospective case series study included 228 patients diagnosed with NSCLC and treated with EGFR TKIs between 2019 and 2022, who died of lung cancer before April 1, 2024. Data on demographics, mutation types, treatment regimens (first-line and subsequent lines), PFS, and OS were collected from hospital records. A Python-based statistical analysis script was developed to evaluate clinical parameters influencing disease progression. Key variables included gender, mutation type, metastatic sites, and first-line treatments (surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy). Descriptive statistics, comparative analyses, and Pearson correlation coefficients were used to assess relationships between clinical parameters and survival outcomes. Results: Most EGFR-mutated patients received first-line monotherapy with EGFR TKIs, with few undergoing combination therapy or subsequent lines of treatment, where chemotherapy was predominant. The co-mutation rates for EGFR exon 19 deletions and L858R were similar (19.4% vs. 19.0%), with median PFS1 of 266 and 220 days, respectively. PFS1 was correlated with OS in first-line TKI-treated patients. No significant OS differences were observed between first-, second-, and third-generation EGFR TKIs, though third-generation TKIs demonstrated more stable OS outcomes. Conclusions: First-line use of third-generation EGFR TKIs may offer superior survival benefits for EGFR-mutated NSCLC patients. However, further clinical exploration is needed to optimize treatment strategies for patients with co-mutations or TKI resistance. This study provides valuable real-world evidence to guide personalized treatment approaches in advanced NSCLC.