Real-World Outcomes and Progression Patterns with First-Line Osimertinib in Patients with Advanced EGFR-Mutant Non-Small Cell Lung Cancer: A Nationwide Turkish Oncology Group Study

Background/Objectives: We aimed to evaluate the real-world outcomes of first-line osimertinib in patients with advanced EGFR-mutant non-small cell lung cancer, together with the progression patterns, including the management and outcomes of oligoprogressive disease in the real-world setting. Methods: Patients who received first-line osimertinib at 33 oncology centers across Türkiye were retrospectively analyzed. Results: The median (IQR) age of 143 patients was 59.4 (50.9–68.9), 62.9% were female, and 68.5% were non-smokers. The most frequently identified EGFR mutations were exon 19 deletion (64.3%) and exon 21 L858R (28.7%). The median progression-free survival (PFS) was 17.6 months (95% CI 14.6–20.6). Exon 19 deletion subgroup had significantly longer median PFS than exon 21 L858R subgroup (22.0 vs. 11.7 months; HR = 0.40 [95% CI 0.25–0.64]; p < 0.001). Of the patients who experienced disease progression, 51.2% had oligoprogression. Among these, 81.8% received local ablative treatments (LATs) while continuing osimertinib. The median time to osimertinib discontinuation was significantly longer in patients treated with LATs than in those who continued osimertinib without LATs (8.5 vs. 3.0 months; p = 0.001). In the overall cohort, 12- and 24-month overall survival (OS) rates were 93.0% and 82.5%, respectively. The median OS was significantly longer in patients with oligoprogression compared to those with systemic progressive disease (57.7 vs. 36.5 months; p = 0.007). Any-grade and grade ≥ 3 osimertinib-related adverse events occurred in 55.2% and 6.3% of patients, respectively. Conclusions: This study supports the real-world effectiveness and tolerability of first-line osimertinib. Oligoprogression was associated with longer OS compared with systemic progression, and the integration of LATs in carefully selected patients with oligoprogression may be associated with prolonged osimertinib treatment duration and favorable post-progression outcomes.

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Journal
Cancers
Published
2026-06-18
DOI
https://doi.org/10.3390/cancers18121979
Primary Topic
Lung Cancer Treatments and Mutations
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article
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article

Real-World Outcomes and Progression Patterns with First-Line Osimertinib in Patients with Advanced EGFR-Mutant Non-Small Cell Lung Cancer: A Nationwide Turkish Oncology Group Study

Bahadır Köylü, Osman Gokhan Demir, Serdar Karakaya, Ahmet Bılıcı et al.
Cancers
Lung Cancer Treatments and Mutations
article

Real-World Outcomes and Progression Patterns with First-Line Osimertinib in Patients with Advanced EGFR-Mutant Non-Small Cell Lung Cancer: A Nationwide Turkish Oncology Group Study

Bahadır Köylü, Osman Gokhan Demir, Serdar Karakaya, Ahmet Bılıcı, Gamze Gököz Doğu, Erkan Arpacı, Ali Murat Tatlı, Taner Korkmaz, Hasibe Bilge Gür, Hakan Kosku, Burak Bi̇lgi̇n, Ozde Melisa Celayir, Orcun Can, İlhan Hacıbekiroğlu, Taha Koray Şahin, O. Er, Saadettin Kılıçkap, Selami Bayram, Şahin Laçin, Yağmur Karaman, Ömer Fatih Ölmez, Teoman Şakalar, Mehmet Alı Nahıt Şendur, Burak Yasin Aktaş, Ozan Yazıcı, Umut Demırcı, Öztürk Ateş, Bülent Karabulut, Ertuğrul Bayram, Başak Oyan, Fatih Selçukbırıcık, A. Aykut, Didem Tunalı, Atila Yıldırım, Metin Kanıtez, Ferhat Ekinci, Perran Fulden Yumuk, Harun Muğlu, Serkan Menekşe, Engin Kut, Fatma Şen, Fatih Kemik, Ahmet Özveren, Abdullah Sakin, Kezban Nur Pilancı, Yeşim Ağyol, Duygu Ercan Uzundal, Gamze Serin Özel, Esra Aşık, Deniz Tural, Ömer Burak Ekinci, Emine Türkmen, Cevat İlteriş Kıkılı, Nilüfer Avcı, Bala Başak Öven, Pinar Gursoy, Elif Sahin, S. Gunduz, Muhammet Ali Kaplan, Nil Molinas Mandel, Erdem Çubukçu, Nazan Demir, Mustafa Özdoğan
article en

Abstract

Background/Objectives: We aimed to evaluate the real-world outcomes of first-line osimertinib in patients with advanced EGFR-mutant non-small cell lung cancer, together with the progression patterns, including the management and outcomes of oligoprogressive disease in the real-world setting. Methods: Patients who received first-line osimertinib at 33 oncology centers across Türkiye were retrospectively analyzed. Results: The median (IQR) age of 143 patients was 59.4 (50.9–68.9), 62.9% were female, and 68.5% were non-smokers. The most frequently identified EGFR mutations were exon 19 deletion (64.3%) and exon 21 L858R (28.7%). The median progression-free survival (PFS) was 17.6 months (95% CI 14.6–20.6). Exon 19 deletion subgroup had significantly longer median PFS than exon 21 L858R subgroup (22.0 vs. 11.7 months; HR = 0.40 [95% CI 0.25–0.64]; p < 0.001). Of the patients who experienced disease progression, 51.2% had oligoprogression. Among these, 81.8% received local ablative treatments (LATs) while continuing osimertinib. The median time to osimertinib discontinuation was significantly longer in patients treated with LATs than in those who continued osimertinib without LATs (8.5 vs. 3.0 months; p = 0.001). In the overall cohort, 12- and 24-month overall survival (OS) rates were 93.0% and 82.5%, respectively. The median OS was significantly longer in patients with oligoprogression compared to those with systemic progressive disease (57.7 vs. 36.5 months; p = 0.007). Any-grade and grade ≥ 3 osimertinib-related adverse events occurred in 55.2% and 6.3% of patients, respectively. Conclusions: This study supports the real-world effectiveness and tolerability of first-line osimertinib. Oligoprogression was associated with longer OS compared with systemic progression, and the integration of LATs in carefully selected patients with oligoprogression may be associated with prolonged osimertinib treatment duration and favorable post-progression outcomes.

CancersVol. 18(12)
Yeditepe University (TR), Sakarya University (TR), Dicle University (TR), Üsküdar University (TR), Ministry of Health (TR), Bursa Uludağ Üni̇versi̇tesi̇ (TR), Koç University (TR), Karadeniz Technical University (TR), Manisa Celal Bayar University (TR), Istanbul Medipol University (TR), Fenerbahçe University (TR), Acıbadem University (TR), Ege University (TR), Ankara Atatürk Eğitim ve Araştırma Hastanesi (TR), Memorial Ankara Hospital (TR), Istanbul Metropolitan Municipality (TR), Ankara Onkoloji Eğitim ve Araştırma Hastanesi (TR), Memorial Sisli Hospital (TR), Hacettepe University Hospital (TR), Sakarya Eğitim ve Araştırma Hastanesi (TR), Istinye University (TR), Istanbul Eye Hospital (TR), Kent Hastanesi (TR), Ankara Yıldırım Beyazıt University (TR), Antalya IVF (TR), Amerikan Hastanesi (TR), Kahramanmaraş Sütçü İmam University (TR), Pamukkale University (TR), Kocaeli Üniversitesi (TR), Cukurova University (TR), Hacettepe University (TR), Marmara University (TR), Gazi University (TR)
Good health and well-being
Openalex Percentile: Top 7%
Lung Cancer Treatments and Mutations
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