Evre III EGFR Mutasyonu Akciğer kanserinde idame yeni tedavi seçeneği olarak Osimertinib

Evre III EGFR Mutasyonu Akciğer kanserinde idame yeni tedavi seçeneği olarak Osimertinib

Akciğer kanseri kadın ve erkeklerde en sık görülen kanser türüdür. Son zamanlarda çok sayıda tedavi seçeneği ile en sık ölümlere neden olan bu kanser türünde olumlu gelişmeler olmuştur.

Evre IV akciğer kanserinde bireye özgü tedavide yüz güldüren sonuçlar mevcut.

Akciğer kanseri tedavisine başlamadan önce artık standart istenmesi gereken mutasyonlar mevcut. Akciğer kanseri tedavisine başlamadan önce bakılması gereken mutasyonlar EGFR, ALK, KRAS, ROS1, BRAF, NTRK1/2/3, METex14skipping, RET, ERBB2 (HER2) ve ayrıca PD-L1 düzeyi tedaviye karar vermede önemli bir belirteç.

Evre III küçük hücreli dışı akciğer tanısı almış ve ameliyat mümkün olmayan hastalarda kemoradioterapi sonrası progresyon olmayan hastalarda durvalumab idame tedavisi standart tedavi seçeneğiydi.

EGFR mutasyonu küçük hücreli akciğer kanserinde, %10-20 oranında görülen, en sık görülen mutasyonlardan biridir.

Son yapılan çalışmada EGFR mutasyonu olanlarda immünoterapi seçeneği olan durvalumab yerine EGFR mutasyonu olanlarda tirozin kinaz inhibitörü olan potent selektif inhibitör Osimertinib verildiğinde hastaların daha az nüks ettiği gösterildi.

Bu çalışmayla Osimertinib, EGFR ekzon 19 ve 21 mutasyonu olan Evre III küçük hücreli dışı akciğer tanısı almış hastalarda kemoradiyoterapi sonrası standart tedavi olacağı öngörülüyor.

Kaynak

Medscape Medical News TOPLINE:

Consolidated osimertinib given after treatment with chemoradiation delays disease progression significantly longer in patients with EGFR-mutated, stage III non–small cell lung cancer (NSCLC) than durvalumab or observation.

METHODOLOGY:

Previous studies have shown consolidation durvalumab improves progression-free and overall survival in patients with stage III NSCLC, but the optimal consolidation in EGFR-mutated disease remains less clear, especially since there is some evidence that immunotherapy can harm these patients.

A retrospective study of 136 patients (median age, 66 years) with EGFR-mutated stage III NSCLC who were treated with concurrent chemoradiation followed by consolidation therapy with osimertinib, durvalumab, or observation between 2015 and 2022.

The primary endpoint was real-world progression-free survival.

The median follow-up time in the study was 46 months.

TAKEAWAY:

Osimertinib prolonged real-world progression-free survival significantly compared with durvalumab (not reached vs 12.7 months; hazard ratio [HR], 0.20) or observation alone (not reached vs 9.7 months; HR, 0.67).

There was no difference in the real-world progression-free survival between durvalumab and observation groups.

Overall survival was similar across the three groups.

The treatment-related adverse event rate was 52% in the osimertinib group and 48% in the durvalumab group. Grade 3 or above adverse event rate was higher with durvalumab (18%) than with osimertinib (6%).

IN PRACTICE:

The authors concluded that consolidation durvalumab does not provide clinical benefit in patients with EGFR-mutated NSCLC and “suggest consolidation osimertinib as a potential future standard of care.”

SOURCE:

This study was led by Amir H. Nassar from Yale University School of Medicine, New Haven, Connecticut, and published online on January 24, 2024, in the Journal of Thoracic Oncology.

LIMITATIONS:

The limitations include retrospective design, selection bias in treatment decisions, uncontrolled timing of EGFR mutation testing in relation to consolidation therapy, and variable follow-up times leading to potential underestimation of treatment-related adverse events in the shorter follow-up cohort.

DISCLOSURES:

This study did not receive any funding. Many authors reported financial relationships with various organizations.