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Treatment Patterns and Clinical Outcomes in Unresectable Stage III EGFR-Mutated Non-Small Cell Lung Cancer in China

Year: 2026

Type: article

Abstract: Following the LAURA study (NCT03521154), the third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) osimertinib was approved for unresectable stage III EGFR-mutated non-small cell lung cancer (NSCLC) after chemoradiotherapy. To inform clinical decision-making, we report real-world (rw) treatment patterns and outcomes in Chinese patients with unresectable stage III EGFR-mutated NSCLC who underwent chemoradiotherapy. Data were retrospectively extracted from the China Multicentre Lung Cancer Precision Medicine Registry medical records of adults with unresectable stage III EGFR-mutated (exon 19 deletion [Ex19del]/leucine-to-arginine substitution at position 858 [L858R]) NSCLC (diagnosed Jan 2016–Dec 2019) who received standard-of-care chemoradiotherapy. The primary outcome was rw progression-free survival (rwPFS) and secondary outcomes were mutation testing patterns, treatment sequencing post-diagnosis, and rw time-to-next treatment or death (rwTTNTD). Of 51 patients, 65%/33% had Ex19del/L858R mutations. As first treatment, 31 patients (61%) received chemoradiotherapy plus EGFR-TKI (mainly first-generation) and 20 (39%) chemoradiotherapy alone. Of 34 (67%) patients who received first-subsequent treatment, most were given EGFR-TKI (88%). In patients who received chemoradiotherapy plus EGFR-TKIs (first-generation) or chemoradiotherapy alone, median (95% confidence interval) rwPFS/rwTTNTD was 22.6 (14.2–34.6)/25.0 (21.5–44.7) or 12.2 (10.5–not estimable)/13.6 (10.5–not estimable) months, respectively. These rw results show that while first-generation EGFR-TKIs are associated with numerically longer rwPFS and rwTTNTD relative to chemoradiotherapy alone in Chinese patients with unresectable stage III EGFR-mutated NSCLC, there remains an unmet need to prolong survival. Patients with stage III non-small cell lung cancer (NSCLC) that cannot be removed by surgery (unresectable disease) typically receive chemotherapy with radiation (chemoradiotherapy; CRT) as their first treatment. However, because the cancer often returns and continues to grow and spread (disease progression), additional treatments are needed. The epidermal growth factor receptor (EGFR) is a protein that controls cell growth and division. Worldwide, approximately a third of patients with NSCLC have tumors harboring EGFR mutations. EGFR-tyrosine kinase inhibitors (EGFR-TKI) are drugs that block mutated EGFR protein activity on cancer cells to reduce disease progression. These are grouped into generations (first, second, and third) based on their development and how they target EGFR mutations. After the global LAURA clinical trial, the third-generation EGFR-TKI osimertinib was approved for treating patients with unresectable stage III EGFR-mutated NSCLC following CRT. To better understand the treatment landscape and outcomes in Chinese patients with this disease, we analyzed medical records from three Chinese hospitals. Most patients received CRT plus an EGFR-TKI as first treatment, and an EGFR-TKI alone as subsequent treatment following disease progression (mainly first-/second-generation EGFR-TKIs). Patients who received CRT plus first-generation EGFR-TKIs tended to stay on treatment longer, and had a longer time between starting treatment and disease progression, than those who received CRT only. This suggests that first-generation EGFR-TKIs are helpful for Chinese patients with unresectable stage III EGFR-mutated NSCLC. However, alternative treatments are needed to further improve outcomes. On the basis of LAURA trial results, third-generation EGFR-TKIs should be considered an important treatment option.

Source: Advances in Therapy

DOI: 10.1007/s12325-025-03488-x