Dr Nassar on Treatment Options After Chemoradiation in Unresectable, Stage III, EGFR-Mutated NSCLC

Amin Nassar, MD, a hematology/oncology fellow, Yale University, Yale School of Medicine, discusses findings from a retrospective study of the use of EGFR TKI therapy, durvalumab (Imfinzi), or observation following concurrent chemoradiation in patients with unresectable, stage III non–small cell lung cancer (NSCLC) harboring EGFR mutations.

Data presented at the 2023 ASCO Annual Meeting showed that EGFR TKIs were associated with significantly longer disease-free survival compared with durvalumab, and there was no difference measured between durvalumab and observation. In the EGFR TKI arm (n = 34), the median DFS was 40.0 months (95% CI, 26.9–not reached) compared with 14.0 months (95% CI, 10.6-48.2) in the durvalumab arm (n = 34) and 10.2 months (95% CI, 5.3-25.4) in the observation arm (n = 21). The 24-month DFS rates were 86%, 28%, and 29%, respectively.

The multicenter, retrospective study included patients with unresectable stage III, locally advanced NSCLC with EGFR sensitizing mutations who received at least 2 cycles of platinum-based chemotherapy concurrently with radiation, Nassar begins. Additionally, patients were not permitted to have experienced disease progression prior to initiation of an EGFR TKI, durvalumab, or observation. The study evaluated DFS, overall survival (OS), and adverse effects (AEs), Nassar explains. Although OS served as a co-primary end point with DFS, the medium follow-up was not sufficient to access OS between the 3 arms, Nassar says.

Regarding safety, 18% of patients treated with an EGFR TKI discontinued treatment due to AEs, compared with 26% of patients in the durvalumab arm. One patient (2.9%) in the TKI arm experienced a grade 3 or higher treatment-related AE vs 2 patients (5.9%) in the durvalumab arm.