Real World Molecular Testing in Patients with EGFR Mutation-Positive Locally Advanced or Metastatic NSCLC in routine practice in Germany – Interim Results of the clinical registry PANORAMA

Introduction: Epidermal Growth Factor Receptor mutations (EGFRm) are among the most common in patients (pts) with non-small cell lung cancer (NSCLC) and can be targeted with EGFR tyrosine kinase inhibitors (TKIs). Appr. 50% of the pts will acquire resistance by the T790M mutation (T790M). Osimertinib (OSI) is a 3rd generation TKI and standard of care for pts who developed the acquired resistance by T790M during the prior TKI treatments, while other strategies, such as chemotherapy is used in T790M negative pts. Increasing evidence from both, clinical studies and registry data suggests that only the minority of patients can benefit from sequential TKI treatment with OSI.

Methods: PANORAMA (NCT02777658) is a prospective, clinical registry for pts with EGFR mutation-positive (EGFRm+) locally advanced or metastatic NSCLC, who progressed after prior TKI therapy. Besides others the 2nd interim analysis (cut-off: 1APR2019) reflects data on routine clinical, molecular testing using descriptive statistics.

Results: This analysis will provide data of 148 evaluable pts: At diagnosis median age was 67.5 yrs (min-max 38.4 – 84.5 yrs), 49 (33%) pts were male and 98 (66%) were diagnosed with NSCLC Stage IV. 124 pts (84%) were tested for EGFRm at diagnosis, the remaining pts at later time points. At time of progression on/after TKI 74/148 pts (50%) were tested again, overall re-test rate after progression at any time was 76% (113 pts). 107 (95%) out of these 113 re-tested pts were tested forT790M thereof 73 pts (64%) were T790M pos (14 pts not yet documented). 55 (75%) pts who were tested T790M pos after progression (n = 73) were treated with OSI. No difference in T790M positivity in the EGFRm subgroups (Ex19Del, L858R) was apparent. Further details on molecular testing will be shown.

Conclusions: The results will help to understand evolving Real World pts management, treatment patterns and associated outcomes among pts with EGFRm locally advanced or advanced NSCLC who have progressed on/after TKI therapy. These data help validating the growing number of data sets suggesting that only a minority of EGFRm NSCLC pts benefit from sequential TKI-treatment with OSI after TKI-progression.

Sponsor: AstraZeneca