Chemotherapy Plus Immunotherapy Versus Chemotherapy Plus Bevacizumab Versus Chemotherapy Alone in EGFR-Mutant NSCLC After Progression on Osimertinib

Optimal treatment of EGFR-mutated lung cancer after progression on osimertinib is unknown. We retrospectively evaluated outcomes in patients who received platinum doublet chemotherapy alone or in combination with immunotherapy or bevacizumab. We found that the addition of immunotherapy to chemotherapy was associated with worse survival; statistically significant differences in survival could not be detected with the addition of bevacizumab to chemotherapy. Introduction: Patients with EGFR-mutant lung cancer who have had disease progression on osimertinib commonly receive platinum doublet chemotherapy, but whether adding immunotherapy or bevacizumab provides additional benefit is unknown. Materials and Methods: This was a retrospective analysis at 2 university-affiliated institutions. Patients with EGFR-mutant lung cancer who had progression on osimertinib and received next-line therapy with platinum doublet chemotherapy (chemo), platinum doublet chemotherapy plus immunotherapy (chemo-IO), or platinum doublet chemotherapy plus bevacizumab (chemo-bev), were identified; patients who continued osimertinib with these regimens were included. Efficacy outcomes including duration on treatment (DOT) and overall survival (OS) from the start of chemotherapy were assessed. Associations of treatment regimen with outcomes were evaluated using adjusted Cox regression models, using pairwise comparisons between groups. Results: 104 patients were included: 57 received chemo, 12 received chemo-IO, and 35 received chemo-bev. In adjusted models, patients who received chemo-IO had worse OS than did those who received chemo (hazard ratio (HR) 2.66, 95% CI 1.25-5.65; P= .011) or those who received chemo-bev (HR 2.37, 95% CI 1.09-5.65; P= .030). A statistically significant difference in OS could not be detected in patients who received chemo-bev versus those who received chemo (HR 1.50, 95% CI 0.84-2.69; P= .17). Conclusion: In this retrospective study, giving immunotherapy with platinum doublet chemotherapy after progression on osimertinib was associated with a worse OS compared with platinum doublet chemotherapy alone. Platinum doublet chemotherapy without immunotherapy (with consideration of continuation of osimertinib, in selected cases) is a reasonable choice in this setting, while we await results of clinical trials examining optimal next-line chemotherapy-based regimens in EGFR-mutant lung cancer. (C) 2021 Elsevier Inc. All rights reserved.

Automated summary

The optimal treatment for EGFR-mutated lung cancer after progression on osimertinib remains unclear. A retrospective study was conducted to evaluate the outcomes of patients who received platinum doublet chemotherapy alone or in combination with immunotherapy or bevacizumab. The results showed that adding immunotherapy to chemotherapy resulted in worse overall survival, while the addition of bevacizumab did not significantly affect survival.