Retrospective study of patterns of failure and post-progression outcomes with first-line osimertinib for advanced EGFR-mutated NSCLC

A retrospective study at the Chinese University of Hong Kong investigated patterns of failure and post-progression outcomes with first-line osimertinib for advanced EGFR-mutated non-small cell lung cancer. The study included 282 patients (64% women, median age 64 years). At disease progression, 37% of patients presented with oligoprogressive disease (OPD) while 63% presented with systemic progressive disease (SPD). Patients with OPD experienced longer time to treatment failure (median 26.0 months versus 14.2 months; HR 0.44; p<0.001) and longer overall survival (median 35.4 months versus 24.8 months; HR 0.57; p=0.01) compared to those with SPD. Local ablative therapy effectively deferred switching systemic therapy among patients who developed OPD; at two years, 35% remained progression-free. Multivariate analysis found ECOG 0-1 and absence of brain/bone/liver metastases at diagnosis were significantly associated with lower odds of disease progression at two years.