Real world treatment patterns and outcomes in metastatic EGFR mutation–positive NSCLC patients: A retrospective study from a tertiary care cancer center in India.

Abstract

1582 Background: Lung cancer is the leading cause of cancer related mortality worldwide with Non small lung cancer (NSCLC) constituting the majority of cases. EGFR mutations, predominantly exon 19 and Exon 21 L858R are actionable targets in approximately 25-30% Indian patients. Third generation EGFR tyrosine kinase inhibitors have set new benchmarks in the treatment of metastatic EGFR mutation positive NSCLC. However real world adoption in India faces significant barriers including financial constraints and healthcare disparities. Methods: Our objective was to evaluate whether patients with EGFR mutation positive metastatic NSCLC receiving the standard of care treatment and analyze demographic, clinical and molecular characteristics of EGFR mutation positive lung cancer patients treated at our center and compare treatment patterns and survival outcomes with national and global data. This retrospective study analyzed 894 stage 4 NSCLC patients treated between 2018-2023 of these 252 (28.1%) were EGFR mutation positive. Data on EGFR types, treatment modalities and survival outcomes were collected and analyzed. Kaplan Meir survival analysis was performed to estimate progression free survival (PFS) and overall survival (OS). Results: First line Osimertinib was median OS was 30 months and PFS was 20 months. The standard of care at that time received by 13.5% only. Other TKI alone (Gefitinib, Erlotinib and Afatinib) median OS was 21 months while PFS was 12 months. Other TKI with chemotherapy median OS 27 months and PFS was 18 months. Mutation specific outcomes showed exon 19 deletions had better overall survival 27 months PFS 16 months compared to Exon 21 L858R (OS 16; PFS 11 months). T790M were identified in 71% patients progressing after first line treatment. Second line osimertinib achieved a median PFS of 9.5 months. Conclusions: Despite the efficacy of osimertinib demonstrated in global trials, its adoption was limited to 13.5% of eligible patients in this cohort due to economic barriers. These findings emphasize the urgent need for systemic interventions to improve access to advanced therapies in India. Policymakers and healthcare systems must address these gaps through measures like government subsidies, expanded insurance coverage and cost effective diagnostic platforms to ensure equitable access to precision oncology in resource limited settings.