Comparison of the efficacy of first‑/second‑generation EGFR‑tyrosine kinase inhibitors and osimertinib for EGFR‑mutant lung cancer with negative or low PD‑L1 expression

Inomata,Minehiko; Minatoyama,Shuhei; Takata,Naoki; Hayashi,Kana; Hirai,Takahiro; Seto,Zenta; Tokui,Kotaro; Taka,Chihiro; Okazawa,Seisuke; Kambara,Kenta; Imanishi,Shingo; Miwa,Toshiro; Hayashi,Ryuji; Matsui,Shoko; Tobe,Kazuyuki

doi:10.3892/mco.2024.2741

Comparison of the efficacy of first‑/second‑generation EGFR‑tyrosine kinase inhibitors and osimertinib for EGFR‑mutant lung cancer with negative or low PD‑L1 expression

Authors:
- Minehiko Inomata
- Shuhei Minatoyama
- Naoki Takata
- Kana Hayashi
- Takahiro Hirai
- Zenta Seto
- Kotaro Tokui
- Chihiro Taka
- Seisuke Okazawa
- Kenta Kambara
- Shingo Imanishi
- Toshiro Miwa
- Ryuji Hayashi
- Shoko Matsui
- Kazuyuki Tobe
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Affiliations: First Department of Internal Medicine, Toyama University Hospital, Toyama, Toyama 930‑0194, Japan, Department of Medical Oncology, Toyama University Hospital, Toyama, Toyama 930‑0194, Japan
Published online on: May 1, 2024 https://doi.org/10.3892/mco.2024.2741
Article Number: 43
Copyright: © Inomata et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

In epidermal growth factor receptor (EGFR)‑mutant non‑small cell lung cancer (NSCLC) with negative or low programmed death ligand‑1 (PD‑L1) expression, the acquisition rate of the T790M mutation is higher after treatment with first‑/second‑generation EGFR‑tyrosine kinase inhibitors (TKIs) and the progression‑free survival (PFS) is longer in patients treated with osimertinib. The present study compared the clinical course after the initiation of each EGFR‑TKI monotherapy in patients with EGFR‑mutant NSCLC with negative or low PD‑L1 expression. Data of patients with EGFR‑mutant NSCLC with negative or low PD‑L1 expression who were treated with EGFR‑TKI monotherapy were retrieved and retrospectively analyzed. Between June 2013 and November 2023, 26 and 29 patients were treated with first‑/second‑generation EGFR‑TKIs and osimertinib, respectively. The PFS time was longer in patients treated with osimertinib (median, 22.5 months) than in those treated with first‑/second‑generation EGFR‑TKIs (median, 12.9 months). However, the EGFR‑TKI treatment duration, defined as the PFS for osimertinib, or the sum of the PFS for first‑/second‑generation EGFR‑TKIs and sequential osimertinib therapy after the acquisition of the T790M mutation, was similar between patients treated with first‑/second‑generation EGFR‑TKIs (median, 23.0 months) and osimertinib (median, 22.5 months). The Cox proportional hazard model suggested that there was no significant difference in the EGFR‑TKI treatment duration between patients treated with first‑/second‑generation EGFR‑TKIs and patients treated with osimertinib (hazard ratio, 1.31, 95% CI, 0.55‑3.13). In conclusion, first‑/second‑generation EGFR‑TKIs and osimertinib were associated with a similar EGFR‑TKI treatment duration in patients with EGFR‑mutant NSCLC with negative or low PD‑L1 expression. The findings suggested that both treatments are promising for this population.

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