Clinical Outcomes and Prognostic Factors of ABCP Therapy in EGFR-mutated NSCLC in the Osimertinib Era

Abstract

Background/Aim: Atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) therapy has demonstrated efficacy in epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) after EGFR-tyrosine kinase inhibitor (TKI) failure. However, real-world evidence in the osimertinib era remains limited. This study aimed to evaluate the efficacy, safety, and prognostic factors of ABCP therapy in patients with EGFR-mutated NSCLC. Patients and Methods: This retrospective study evaluated patients with EGFR-mutated NSCLC who received ABCP therapy after EGFR-TKI failure at two institutions between January 1, 2019 and March 31, 2025. Progression-free survival (PFS), overall survival (OS), treatment response, and safety were evaluated, and prognostic factors were identified. Results: Sixty-one patients were evaluated. The median PFS and OS were 6.9 months [95% confidence interval (CI)=4.7-8.2] and 20.2 months (95% CI=12.9-25.5), respectively. The objective response rate was 59.0%. Stage IVB disease [hazard ratio (HR)=2.41, p=0.004] and Eastern Cooperative Oncology Group performance status (ECOG PS) score ≥2 (HR=5.10, p=0.007) were significantly associated with shorter PFS. Stage IVB disease (HR=2.29, p=0.014), ECOG PS score ≥2 (HR=15.06, p<0.001), and liver metastasis (HR=3.21, p=0.007) were significantly associated with shorter OS. Stage IVB disease and ECOG PS score ≥2 were independent prognostic factors for both PFS and OS. Prior osimertinib treatment was not significantly associated with either PFS or OS. No unexpected safety signals were observed. Conclusion: ABCP therapy was associated with a median PFS of 6.9 months and median OS of 20.2 months, with no unexpected safety signals in patients with EGFR-mutated NSCLC after EGFR-TKI failure. Stage IVB disease and poor ECOG PS are independent prognostic factors for survival, whereas prior osimertinib treatment is not significantly associated with survival outcomes. Overall, stage IVB disease and poor ECOG PS were associated with survival outcomes, whereas prior osimertinib exposure was not significantly associated with PFS or OS in this cohort.