Prognostic factors and outcomes of patients with advanced non-small-cell lung cancer treated with osimertinib: a retrospective database study

<h3>Background</h3> The purpose of this study was to describe patient profiles and real-world outcomes and identify prognostic factors among patients with common epidermal growth factor receptor (<i>EGFR</i>)–mutated advanced non-small-cell lung cancer (NSCLC) treated with first-line (1L) or second-line (2L) osimertinib. <h3>Patients and methods</h3> This retrospective study used data from the Epidemiological Strategy and Medical Economics (ESME; France), Rigshospitalet/Herlev Hospital (RH; Denmark), and National Cancer Registration and Analysis Service (NCRAS; UK) databases. Progression-free survival (PFS), time to treatment discontinuation (TTD), time to next therapy (TTNT), and overall survival (OS) were analyzed using Kaplan–Meier estimates. Prognostic factors for outcomes were identified using univariate and multivariable proportional hazards regression. <h3>Results</h3> A total of 1646 patients were included (ESME, <i>n</i> = 624; RH, <i>n</i> = 133; NCRAS, <i>n</i> = 889). For patients receiving 1L osimertinib, median PFS, TTD, TTNT, and OS were 11.9, 15.0, 18.8, and 24.8 months, respectively. Corresponding values for 2L osimertinib were 7.4, 10.0, 11.9, and 17.1 months. Although distinct prognostic factors were identified for different outcomes and lines of treatment, poor Eastern Cooperative Oncology Group performance status score, presence of exon 21 L858R substitutions, and liver metastases were consistently associated with poorer outcomes across all endpoints. Of 771 patients receiving 1L osimertinib, at least 38% died before initiating a 2L treatment; 41% of patients receiving 2L osimertinib (<i>n</i> = 875) died before initiating a third-line treatment. The most common subsequent therapy was chemotherapy [1L osimertinib, 47% (97/208); 2L osimertinib, 52% (193/368)]. <h3>Conclusion</h3> This retrospective real-world analysis highlights the unmet need for more effective treatment options in common <i>EGFR</i>-mutated advanced NSCLC.