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Lung cancer is the malignant tumor with the highest mortality rate in the world, of which non-small cell lung cancer (NSCLC) accounts for 80%~85%
of all lung cancer types.
Studies have found that although nearly one-third of NSCLC patients can undergo surgery, the prognosis of surgery is not ideal [1].
Since NSCLC officially opened the era of molecularly targeted therapy, EGFR-TKIs have been widely used in clinical practice, bringing hope to many patients
.
EGFR-TKIs also bring good news to patients after early NSCLC surgery, and whether they can be the hope of improving the prognosis of patients with early EGFR mutation NSCLC needs to be explored
.
At the 2022 ESMO Annual Meeting, a study from France retrospectively analyzed the incidence of EGFR mutations, clinical and tumor characteristics, and disease recurrence patterns in surgically treated NSCLC patients [2].
Details of the study
1
Research background
According to previous studies, there are few epidemiological and clinical dataon surgical treatment of patients with EGFR mutant NSCLC.
In the ADAURA study, osimertinib was used as an adjuvant treatment regimen in patients with stage IB-III EGFR-mutant NSCLC after complete surgical resection with significantly improved
disease-free survival (DFS).
The EXERPOS-GFPC study was designed to explore EGFR mutation rates and prognosis in NSCLC patients undergoing surgery to evaluate patients
who may benefit from adjuvant therapy with osimertinib.
2
Study design
The main inclusion criteria for the EXERPOS-GFPC study were: patients with local NSCLC who underwent continuous surgery in France from January 2018 to December 2019, and the study collected data including demographic and clinical data, type of surgery, stage, disease recurrence, and treatment incase of disease recurrence.
When EGFR status cannot be obtained from medical records, the investigator will retrospectively examine
the patient's EGFR status.
3
Study results
The EXERPOS-GFPC study ultimately screened 1165 patients with local NSCLC who underwent continuous surgery at 16 centers and retrospectively examined the EGFR status of 699 (60%) of them [2].- Baseline characteristics of patients (Table 1): EGFR mutations were carried in 11.
5 percent (n=134) of patients, with a median age of 69.
5 (36 to 88) years, 62 percent of women, 74 percent of never-smokers, 96 percent of adenocarcinoma, and 0 percent/1-49 percent/≥ 50 percent of PD-L1 (TPS) status, respectively [2].
。
Table 1 Baseline characteristics of patients
- Surgical type: 85%, 10%, 4% and 1% of patients underwent lobectomy, segmentectomy, wedge resection, and total pneumonectomy, respectively, of which about 96% of patients completed lymph node dissection through video thoracoscopy, thoracotomy, and robotic-assisted lymph node dissection, accounting for 43%, 37%, and 13%, respectively, and the surgical resection rates of R0 and R1 were 97% and 3%, respectively [2].
。 - Postoperative stage: 63 cases (47%) in stage IA, 22 cases (16%) in stage IB, 5 cases (3.
7%) in stage IIA, 15 cases (11.
2%) in stage IIB, 26 cases (19.
4%) in stage IIIA, and 4 cases (0.
03%)
in stage IIIB 。 EGFR mutation types: exome DEL19/21(L858R)/20/18/others 39.
5%/39.
5%/12%/7%/1.
5%, respectively; Twenty-eight (21%) patients received adjuvant therapy, including 25 (92%) patients who received adjuvant chemotherapy and three (8%) patients who received EGFR-TKI [2].
- Disease recurrence and metastasis: after a median follow-up of 29.
4 months, 38 (28%) patients had disease recurrence (IA/IB/IIA-IIB/IIIA: N=9/N=3/N=11/N=15), OF WHICH 31 (82%) PATIENTS HAD METASTATIC PROGRESSION (26%, 23%, AND 23% OF BRAIN, BONE, AND LUNG METASTASES, RESPECTIVELY), AND 18 (47%) PATIENTS HAD LOCAL RECURRENCE [2]
。
Expert reviews
Professor Yu Dongliang
The Second Affiliated Hospital of Nanchang University
NSCLC is the main pathological type of lung cancer morbidity and mortality, and about 30% of patients have resectable early and intermediate NSCLC
at diagnosis.
However, relatively little attention has been paid to its treatment and management, especially the indications and contents of molecular testing after complete tumor resection in NSCLC patients, the indications and regimen selection of adjuvant therapy, and the management of postoperative follow-up, all of which are non-standard and controversial [3].
In addition, many patients with NSCLC still have a high risk of recurrence and death after receiving postoperative adjuvant chemotherapy, and reasonable and effective adjuvant therapy needs to be explored
.
The advent of EGFR-TKI ushered in a new era
of NSCLC-targeted therapy.
At present, the first generation of EGFR-TKIs includes gefitinib, erlotinib and eclitinib, and the third generation of EGFR-TKI osimertinib has shown strong strength in postoperative adjuvant therapy for NSCLC, significantly prolonging DFS in patients with EGFR mutant NSCLC, opening a new chapter in adjuvant targeted therapy for lung cancer, and bringing patients hope for long-term survival [1].
。 The EXERPOS-GFPC study leverages this advantage of osimertinib to provide us with
EGFR mutation rates and prognosis for surgically treated NSCLC patients.
The results of this study indicate that the EGFR mutation rate in patients undergoing NSCLC surgery in France is similar to that in advanced patients, with a recurrence rate of more than 10% in patients with stage IA-IB and more than 50% in patients with stage II-IIIA [2].
This study identified patients who were eligible for adjuvant osimertinib based on the results of the ADAURA study [2], and it is hoped that it will bring survival benefits
to more patients in future clinical studies.
Expert profiles
Professor Yu Dongliang
Director of the Department of Thoracic Surgery, Second Affiliated Hospital of Nanchang University
Chief physician and doctoral supervisor
Chairman of the Department of Thoracic Surgery of Jiangxi Research Hospital Association
National Committee Member of Thoracic Branch of Chinese Medical Doctor Association
National Committee Member of Chest Branch of China Association for the Promotion of Healthcare
National Committee Member of the Thoracic Surgery Branch of the Wu Jieping Foundation Simulation Medical Association
Vice Chairman of the Lung Cancer Group of the Thoracic and Cardiovascular Surgery Branch of Jiangxi Medical Association
Vice Chairman of the Lung Cancer Expert Committee of Jiangxi Cancer Medical Quality Control Center
Vice Chairman of the Esophageal Cancer Professional Committee of Jiangxi Anti-Cancer Association
of healthcare professionals only.
References:
[1] Ortega-Franco A, Rafee S.
ADAURA: The Splash of Osimertinib in Adjuvant EGFR-Mutant Non-small Cell Lung Cancer[J].
Oncology and Therapy, 2022, 10（1）: 13-22.
[2] Auliac J B, Simmoneau Y, Thomas P A, et al.
937P Incidence and outcomes of EGFR mutated non-small cell lung cancer treated with surgery: EXERPOS GFPC study[J].
Annals of Oncology, 2022, 33: S976.
[3] Lung Cancer Professional Committee of Chinese Anti-Cancer Association, Lung Cancer Group of Oncology Branch of Chinese Medical Association, Chinese Thoracic Cancer Research Collaborative Group.
Guidelines for adjuvant therapy after complete resection of stage I.
~III.
B non-small cell lung cancer (2021 edition)[J].
Chinese Medical Journal,2021,101(16):1132-1142.
)
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