Real-world outcomes of caucasians with EGFR -mutated non-small-cell lung cancer treated with surgery (EXERPOS-2 GFPC study)

Abstract

Little is known about the natural history of epidermal growth factor receptor ( EGFR) -mutated non-small-cell lung cancer (NSCLC) in Caucasian patients treated with surgery before the generalization of adjuvant treatment with osimertinib. The primary objective of this study was to describe the outcomes of such patients and their relapse modalities. French multicenter retrospective study. Consecutive patients with early-stage EGFR -mutated NSCLCs, treated surgically between January 2018 and December 2020, were included in the analysis; osimertinib became available as adjuvant therapy in France in 2022. The following information was collected: patient characteristics, type of surgery, disease-free survival (DFS), progression modalities and overall survival (OS). The 291 patients analyzed were managed in 17 centers: median age: 70 (IQR: 34–85) years, 69% female, 78% never smokers, 99% adenocarcinoma, with 36% and 41% of them having exon19 or L858R mutations, respectively. Surgical resections were predominantly lobectomy (84%) and segmentectomy (12%), with 97% having complete lymph-node dissection; 96% of resections were R0. Post-surgery stages were deemed I, II and III, respectively, in 61%,18% and 21%; 82/291 (28%) patients received adjuvant treatment, 50/291 (17%) chemotherapy, 28/291 (9.6%) an EGFR-tyrosine-kinase inhibitor. After median follow-up of 35 (95% CI 16–82) months, disease progressed in 89/291 (30.5%) patients: stage I, II and III, respectively, 32/178 (18%), 22/52 (42%) and 35/61 (58%). Their respective 2- and-3-year DFS rates were 79% and 68%. DFS was not reached (NR) for stage I but lasted 41 (95% CI 41–NR) and 29 (95% CI 23-44) months for stages II and III. Two- and 3- year OS rates were 94% and 90%, respectively. In conclusion, in the absence of adjuvant therapy, around 30% of patients with surgically resected EGFR -mutated NSCLCs had poor outcomes .