Efficacy of immunochemotherapy compared with platinum-based chemotherapy and immunotherapy after tyrosine kinase inhibitor failure in advanced non-small cell lung cancer patients with EGFR mutation

Abstract BackgroundPatients with epidermal growth factor receptor (EGFR)-mutated, advanced non-small cell lung cancer have received immunochemotherapy as one of the treatment options after tyrosine kinase inhibitor (TKI) failure. We examined the efficacy of immunochemotherapy in actual clinical practice and investigated subgroups of EGFR-mutant patients suitable for immunochemotherapy.MethodsWe conducted a multicenter retrospective cohort study of EGFR-mutant patients treated with atezolizumab-bevacizumab-carboplatin-paclitaxel (ABCP) therapy versus platinum-based chemotherapy (Chemo) and immune checkpoint inhibitor (ICI) monotherapy after EGFR-TKI therapy. Progression-free survival (PFS), according to underlying factors, including programmed death-ligand 1 (PD-L1) status, was also analyzed between the ABCP and Chemo groups.ResultsOf the 65 patients, 20, 37, and 8 received ABCP therapy, chemotherapy, and ICI monotherapy, respectively. The median PFS and overall survival periods in the ABCP, Chemo and ICI groups were 5.6 and 20.9 months, 5.4 and 22.1 months, and 1.2 and 9.2 months, respectively (PFS, P = 0.63; OS, P = 0.11). The median PFS periods of PD-L1-positive patients in the ABCP and Chemo groups were 6.9 and 4.7 months, respectively (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.41–2.17, P = 0.89). The median PFS of PD-L1-negative patients in the Chemo group (8.7 months) was significantly longer than that in the ABCP group (4.6 months) (HR, 0.34; 95% CI, 0.12–0.97, P = 0.04).ConclusionsThe effect of ABCP therapy was similar to chemotherapy in EGFR-mutant patients in a real-world setting. Particularly, for PD-L1-negative patients, platinum-based chemotherapy may be recommended over ABCP therapy.