Multicenter retrospective study of long-term benefit with first-line osimertinib monotherapy in EGFR-mutated advanced NSCLC

First-line osimertinib monotherapy remains a standard treatment for advanced EGFR-mutated non-small cell lung cancer (NSCLC), although intensified regimens improve outcomes at the cost of increased toxicity and treatment burden. A retrospective study at 25 centers in Japan investigated pretreatment clinical features associated with long-term benefit (LTB; boths progression-free survival ≥ 24 months and overall survival ≥ 48 months) with osimertinib monotherapy for advanced or recurrent EGFR-mutated NSCLC. Among 803 included patients, 204 (25.4%) experienced LTB. The six independently associated factors were age < 75 years, ECOG performance status 0 or 1, serum albumin level ≥ 3.5 g/dl, postoperative recurrence (versus advanced disease), EGFR exon 19 deletion, and absence of liver metastasis. LTB rates were 2.5% among patients with 0-2 factors, 19.0% among patients wit 3 or 4 factors, and 50.7% among patients with 5-6 factors (p for trend <0.001), with median progression-free survival 7.2, 16.8, and 30.5 months, and median overall survival 12.7, 35.9, and 68.3 months, respectively. The authors conclude that these results may support prognostic stratification regarding the likelihood of durable outcomes with first-line osimertinib monotherapy for advanced or recurrent EGFR-mutated NSCLC.