Real-world clinical practice and outcomes in Peruvian patients with advanced EGFR T790M mutation positive NSCLC: A multicenter analysis

Abstract

Introduction: Despite osimertinib being the standard therapy for advanced EGFR T790M mutation positive NSCLC, in many Latin American countries, access to molecular testing and targeted therapies is limited, directly impacting patient outcomes. This study describes the real-world management and outcomes of Peruvian patients with advanced EGFR-mutated NSCLC who develop the T790M mutation.

Methods: We conducted a multicenter retrospective study including patients from nine Peruvian institutions, both public and private, who progressed to first-line EGFR TKI and developed T790M mutation, detected between January 2018 and December 2023. We evaluated demographic, clinico-pathological features and treatment data, including diagnostic pathway, treatment patterns, and survival outcomes.

Results: Seventy-eight patients were included; T790M was detected by liquid biopsy in 52.6 % of cases. Median time from progression to T790M detection was 59.5 days (7-244). Osimertinib was administered to 62.8 % of patients after detection, with a median initiation time of 42 days (1-104). Median overall survival (OS) from first-line treatment was 46.6 months for patients who received osimertinib, 23.9 months for those receiving other therapies, and 16.1 months for those without treatment (p = 0.001). Among osimertinib-treated patients, the objective response rate (ORR) was 59.2 %, with a median progression-free survival (PFS) of 15.8 months. Median OS from osimertinib initiation was 16.3 months, significantly longer than for patients receiving other treatments after T790M detection (9.7 months; p = 0.002).

Conclusions: This study confirms the real-world effectiveness of osimertinib in Peruvian patients with advanced EGFR T790M positive NSCLC and highlights the importance of timely detection and access to targeted therapies.

Keywords: EGFR; Osimertinib; Real-world; T790M.