EGFR positivity may be a poor predictor of recurrence in patients with resected, early-stage non-small cell lung cancer (NSCLC), according to a study published in JAMA Network Open.

The study showed that, despite high rates of recurrence in EGFR-positive NSCLC, 37% of patients with stage IB-IIIA NSCLC remained disease-free at 5 years.

The study included patients treated for NSCLC at the National Cancer Centre Singapore between January 1, 2010, and June 30, 2018. The study was designed to determine risk factors for recurrence in early-stage, EGFR-positive NSCLC and inform adjuvant treatment decisions.


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The researchers analyzed 723 patients, 389 with EGFR-positive NSCLC and 334 with wildtype EGFR. About half of patients were women, and the median age was 64 years (range, 22-88 years). Patients had stage IA (41.4%), stage IB (21.4%), stage II (19.5%), and stage IIIA (17.3%) NSCLC.

All patients underwent surgery. For adjuvant therapy, 6.9% of patients received radiation, and 22.7% received platinum doublet chemotherapy. There were no significant differences between the EGFR-positive and wildtype groups with regard to adjuvant radiotherapy or chemotherapy.

In the EGFR-positive group, 4.6% of patients received neoadjuvant EGFR tyrosine kinase inhibitors (TKIs), and 2.8% received adjuvant EGFR TKIs.

Recurrence and Survival

The median follow-up was 46 months, and the median time to recurrence was 16 months.

There was no significant difference between EGFR-positive and wildtype patients in 2-year disease-free survival (DFS) — 70.2% and 67.6%, respectively (P =.70) — or 5-year DFS — 50.3% and 50.0%, respectively (P =.70). In addition, sites of disease recurrence were similar between the groups.

However, EGFR-positive patients did have better overall survival than wildtype patients at both 2 years — 95.5% and 88.0%, respectively (P =.004) — and 5 years — 77.7% and 66.6%, respectively (P =.004).

In the EGFR-positive group, the 2-year DFS rate was 81.0% for patients with stage IA disease, 78.4% for stage IB, 57.1% for stage II, and 46.6% for stage IIIA. The 5-year DFS rate for EGFR-positive patients with stage IB-IIIA disease was 37.2%.

In the EGFR wildtype group, higher disease stage, lymphovascular invasion, and adjuvant radiation were associated with recurrence in multivariate analyses.

In EGFR-positive patients, higher disease stage, nonacinar and nonlepidic adenocarcinoma subtype, sublobar resection, positive resection margins, and lymphovascular invasion were all associated with recurrence in multivariate analyses.

“The findings of this cohort study agree with previous research findings that recurrence rates in early-stage EGFR-positive NSCLC are high, including stage IA, yet a significant number of patients remain disease-free at 5 years without osimertinib,” the researchers concluded.

They added that prospective studies are needed to identify patients who will benefit from adjuvant osimertinib and those who may be cured without adjuvant treatment.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Saw SPL, Zhou S, Chen J, et al. Association of clinicopathologic and molecular tumor features with recurrence in resected early-stage epidermal growth factor receptor–positive non–small cell lung cancer. JAMA Netw Open. Published online November 5, 2021. doi:10.1001/jamanetworkopen.2021.31892

This article originally appeared on Cancer Therapy Advisor