UNcommon EGFR mutations: International Case series on efficacy of osimertinib in Real-life practice in first liNe setting (UNICORN)
Abstract
BACKGROUND
About 10% of EGFR mutations (EGFRmut) are 'uncommon mutations' (ucEGFRmut). We aimed to collect real-world data about osimertinib for ucEGFRmut patients.
METHODS
This is a multi-center, retrospective study of ucEGFRmut (exon 20 insertions excluded) metastatic NSCLC osimertinib-treated as first EGFR inhibitor. RECIST and RANO-BM brain objective response rate (ORR) were evaluated by investigators. mPFS, mOS and mDOR were calculated from osimertinib initiation. Mutations found at resistance were collected.
RESULTS
60 patients included (22 centres, 9 countries): median age - 64 years, 75% females, 83% Caucasian. The largest subgroups were G719X (30%), L861Q (20%) and de novo T790M (15%). ORR was 61%, mPFS 9.5 months (m), mDOR 17.4m, mOS 24.5m. Regarding patients with no concurrent common mutations or T790M (group A, n=44), ORR was 60%, mPFS 8.6 months, mDOR 11 months. For G719X ORR was 47%, mPFS 8.8m and mDOR 9.1m. For L861Q ORR was 80%, mPFS 16m and mDOR 16m. For de novo T790M ORR was 44%, mPFS 12.7m, mDOR 46.2m. Compound EGFRmut including common mutations had better outcome compared to only ucEGFRmut. For 13 patients with a RANO-BM evaluable brain metastases, brain ORR was 46%. For 14 patients, rebiopsy was analysed: 4 patients - additional EGFR mutation (C797S, D585Y, E709K), 3 - new TP53 mutation, 1 - c-Met amplification, 1 - PIK3CA mutation and 1 - neuroendocrine transformation.
CONCLUSIONS
Osimertinib demonstrated activity in ucEGFRmut with high rate of disease…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 60 participants or records.
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