Real-World Survival Outcomes in EGFR-Mutant Advanced NSCLC Treated With EGFR TKIs: Insights From a Single-Center Clinical Data Warehouse Analysis in South Korea.

[PURPOSE] This study aims to evaluate real-world survival outcomes of patients with epidermal growth factor receptor (EGFR)-mutant advanced non-small cell lung cancer (NSCLC) by the generation of EGFR tyrosine kinase inhibitor (TKI) as a first-line treatment.

[METHODS] A total of 893 patients with advanced EGFR-mutant NSCLC between January 2010 and June 2020 were identified through the clinical data warehouse-fully aligned with the electronic medical records-at Seoul National University Hospital in South Korea. Kaplan-Meire and multivariate Cox proportional hazard regression analyses were conducted to explore the overall survival (OS) between patients treated with first-/second-generation as their first-line treatment (1G/2G first) and third generation first-line EGFR TKIs (3G first).

[RESULTS] Of the 893 patients, 831 patients (93.1%) were in the 1G/2G first group, and 62 patients (6.9%) were in 3G first group. In 1G/2G first group, 324 (39.0%) switched to the next therapy with 3G EGFR TKI. The median OS for 1G/2G first group was 35.6 months (95% confidence interval [CI]: 31.1-39.1) and those for 3G first group was 47.6 months (95% CI: 41.4-not estimable [NE]). Multivariate Cox regression analysis revealed that first-line treatment with 3G EGFR TKIs conferred a significant survival benefit compared with 1G/2G TKIs (HR: 0.64; 95% CI: 0.45-0.92; p = 0.015). In addition, subgroup analysis showed that patients with brain metastases had significantly better survival with first-line 3G EGFR TKIs than with 1G/2G agents (HR: 0.54; 95% CI, 0.31-0.94; p = 0.031).

[CONCLUSION] Based on real-world data, first-line treatment with 3G EGFR TKIs demonstrated a significant survival benefit compared with 1G/2G EGFR TKIs.