Can osimertinib be used as first-line therapy in older patients with EGFR-mutated NSCLC?

This study evaluated the effectiveness and safety of osimertinib (Tagrisso) as first-line therapy for older patients above 75 years with epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC). The data showed that osimertinib as first-line therapy is effective in these patients. However, osimertinib was associated with a high risk of developing lung inflammation and the authors advise it with special caution.

NSCLC is the most common form of lung cancer. NSCLC is responsible for around 85% of all lung cancer diagnoses. Standard treatment for advanced NSCLC involves surgical removal of solid tumors, chemotherapy, and targeted therapy.

Genetic mutations (abnormalities) in the EGFR can lead to NSCLC. EGFR helps cancer cells grow and spread faster. EGFR TKIs, such as gefitinib (Iressa) and erlotinib (Tarceva), are drugs used to block the activity of these proteins. TKI is a type of targeted therapy that works by blocking the growth of cancer cells. Osimertinib is a newer generation of EGFR-TKI that is approved for the treatment of advanced EGFR-mutant NSCLC. Osimertinib has been shown to improve survival outcomes for these patients. However, there are few studies evaluating the effectiveness and safety of osimertinib as first-line therapy for elderly patients above 75 years with EGFR-mutated NSCLC.

This study involved 132 patients with EGFR-mutated NSCLC who were older than 75 years. All patients received osimertinib as a first-line treatment. The average follow-up time was 20.5 months.

The average survival without cancer worsening was 19.4 months. After 1 year, 65.8% of the patients were alive without cancer worsening. The average overall survival was not reached (exceeded the follow-up period).

Overall, 75.2% of the patients responded to the treatment. 92.9% of the patients achieved disease control (tumor does not grow or spread).

17.4% of the patients developed pneumonitis (inflammation of the lung) and the average overall survival of patients who had developed pneumonia was poorer (15.8 months). Overall, 41.7% of the patients experienced severe side effects. The most common side effects were skin infection around the toenails or fingernails, rash, dry skin, and anemia.

This study concluded that osimertinib is effective as first-line therapy in elderly patients above 75 years with EGFR-mutated NSCLC. However, osimertinib was associated with a high risk of developing pneumonitis and the authors advise it with special caution.

The sample size was small and the study looked back in time at medical records. Larger studies are needed to fully validate the conclusions.