Epidermal growth factor receptor tyrosine kinase inhibitor treatment response in advanced non-small cell lung cancer with uncommon mutations: A multicenter observational study

Background Treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) is the standard therapy for advanced non-small cell lung cancer (NSCLC) with common EGFR mutations. However, the efficacy of EGFR-TKIs in patients with uncommon EGFR mutations remains unclear. Methods We retrospectively surveyed a consecutive database of patients with NSCLC with EGFR mutations. We analyzed the data of patients with NSCLC with uncommon mutations, including single or compound mutations, who were treated with EGFR-TKIs between May 2016 and October 2018. Results Data from 543 patients were collected from five institutions, among whom 23 had EGFR uncommon mutations. Twenty-one patients who were treated with any EGFR-TKIs were analyzed in this study, 18 of whom were treated with EGFR-TKIs as first-line therapy (gefitinib 5, erlotinib 3, afatinib 10 patients). In contrast, three patients underwent cytotoxic chemotherapy as first-line therapy and were treated with EGFR-TKIs as second- and third-line therapy (gefitinib 1, erlotinib 1, afatinib 1 patient). According to the Response Evaluation Criteria in Solid Tumors, the overall response rate was 56%, and the disease control rate was 78%. The median progression-free survival (PFS) was 14.0 months in all patients with uncommon mutations. The median PFS of patients who were treated with first and second generation EGFR-TKIs were 14.0 months (n = 10) and 7.3 months (n = 11), respectively. Moreover, the PFS of patients with the G719X mutation (n = 12, median PFS: 32.9 months) was longer than that of patients with the L861Q mutation (n = 4, median PFS: 11.1) and compound mutations (n = 4, median PFS 7.3 months). Conclusions First and second generation EGFR-TKIs are effective treatments for patients with NSCLC with uncommon mutations. Notably, a greater favorable response was observed in patients with G719X mutations than those with L861Q and compound mutations. Clinical trial identification UMIN000028989. Legal entity responsible for the study Fumio Imamura. Funding AstraZeneca. Disclosure F. Imamura: Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): AstraZeneca. All other authors have declared no conflicts of interest.