Clinical efficacy of osimertinib and icotinib in first-line treatment of EGFR-positive metastatic NSCLC / 国际肿瘤学杂志

ABSTRACT

Objective:To investigate the real-world efficacy of osimertinib and icotinib in metastatic non-small cell lung carcinoma (NSCLC) patients.Methods:A retrospective analysis was performed on clinical data of 151 newly-diagnosed patients with epidermal growth factor receptor (EGFR) -positive advanced NSCLC in Renmin Hospital of Wuhan University from March 2018 to May 2022. The patients were divided into osimertinib group ( n=53) and icotinib group ( n=98) according to treatment method. The objective response rate (ORR) , disease control rate (DCR) , progression-free survival (PFS) and overall survival (OS) were compared between the two groups. The factors influencing prognosis were analyzed by using Cox regression models. Subgroup analysis was performed according to metastatic site and EGFR mutation type. Results:ORR was 56.6% (30/53) and 59.2% (58/98) for patients in the osimertinib group and icotinib group, respectively, with no statistically significant difference ( χ2=0.09, P=0.759) . DCR was 83.0% (44/53) and 91.8% (90/98) for patients in the osimertinib group and icotinib group, respectively, with no statistically significant difference ( χ2=2.68, P=0.102) . The median PFS was 11.7 months and 11.8 months for patients in the osimertinib group and icotinib group, respectively, with no statistically significant difference ( χ2=0.06, P=0.802) . The median OS was not reached for patients in both the osimertinib group and icotinib group, with no statistically significant difference ( χ2<0.01, P=0.969) . The results of multivariate analysis showed that adrenal metastases ( HR=1.89, 95% CI 1.04-3.41, P=0.036) was an independent prognostic factor for PFS. Gender ( HR=2.22, 95% CI 1.08-4.58, P=0.031) and adrenal metastases ( HR=4.87, 95% CI 1.76-13.46, P=0.002) were independent prognostic factors for OS. The results of the subgroup analysis showed that in patients with pleural metastases (median PFS 11.7 months vs. 9.3 months, median OS not reached vs. not reached) , adrenal metastases (median PFS 8.7 months vs. 5.6 months, median OS 20.0 months vs. 15.3 months) , 19DEL mutations (median PFS 14.5 months vs. 13.3 months, median OS not reached vs. 40.7 months) , the osimertinib group tended to have better survival outcomes. Conversely, in patients with contralateral lung metastases (median PFS 8.3 months vs. 11.2 months, median OS not reached vs. 40.7 months) , bone metastases (median PFS 11.7 months vs. 11.8 months, median OS not reached vs. 34.5 months) , liver metastases (median PFS 8.7 months vs. 9.1 months, median OS not reached vs. 23.8 months) , brain metastases (median PFS 11.7 months vs. 15.3 months, median OS 22.4 months vs. 35.3 months) and 21L858R mutations (median PFS 9.5 months vs. 10.0 months, median OS 22.4 months vs. not reached) , the icotinib group tended to have better survival outcomes, but with no statistically significant differences (all P>0.05) . Conclusion:Both osimertinib and icotinib have good therapeutic efficacy in patients with EGFR-positive advanced NSCLC, thus can be used as first-line treatment options.