NSCLC with uncommon EGFR mutations treated with Atezolizumab plus Bevacizumab and Chemotherapy
Menée en Allemagne auprès de 16 patients atteints d'un cancer du poumon non à petites cellules présentant des mutations EGFR inhabituelles, cette étude rétrospective évalue l'efficacité, du point de vue de la survie sans progression et de la survie globale, d'un traitement combinant atézolizumab, bévacizumab et chimiothérapie (carboplatine et (nab-)paclitaxel)
Objectives : For refractory NSCLC patients with EGFR mutations, recent studies have demonstrateda favorable response to the combination of anti-angiogenic therapy and checkpointinhibition but included only very few patients with uncommon EGFR mutations for whichtreatment options are still limited despite new targeted treatments. Materials and Methods : Sixteen stage IV NSCLC patients with uncommon EGFR mutations from 9 different Germancenters were treated in first or further line with Atezolizumab, Bevacizumab, Carboplatin and (nab-)Paclitaxel (ABCP). PFS was evaluated from start of ABCP and OS from time of initial diagnosis of stage IV. Results : Patients with either an Exon 20 insertion (n=9) or other uncommon EGFR mutations (n=7)received ABCP in first, second or further line. Nine patients had received a TKI therapyin first line with an ORR of 66.7% and a median time-to-next-treatment of 6.7 months.After a median number of 4 ABCP cycles, 4 patients (25.0%) required a dose reductionof chemotherapy and 5 patients (31.3%) suffered from grade 3 or 4 toxicity. Overallresponse rate was 81.3% and disease control rate 87.5%. 14 patients (87.5%) receiveda maintenance with AB and the median follow-up after initial diagnosis was 24.3 months. Median PFS was 13.6 months for both the entire cohort and for Exon 20 insertions.Corresponding median OS was either not reached or 30.7 months. Landmark analysis at12 months gave a PFS of 42.8% and an OS of 93.3%. Four patients were rechallengedwith ABCP while progressing under maintenance and responded again. In further linetherapy, clinical benefit was achieved in all of 3 patients receiving Amivantamab,but in only one of four patients receiving mobocertinib. Conclusion : In this retrospective analysis, ABCP achieves an encouraging outcome for patientswith uncommon EGFR mutations and is a valuable option in the early treatment course.
Lung Cancer 2022