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. 2023 Apr 3;4(5):100513.
doi: 10.1016/j.jtocrr.2023.100513. eCollection 2023 May.

Incidence of Bone Metastases and Skeletal-Related Events in Patients With EGFR-Mutated NSCLC Treated With Osimertinib

Anita J W M Brouns  1   2   3 , Ard van Veelen  4   5 , G D Marijn Veerman  6   7 , Christi Steendam  6 , Safiye Dursun  2 , Cor van der Leest  8 , Sander Croes  4 , Anne-Marie C Dingemans  2   3   6 , Lizza E L Hendriks  2   3
Affiliations

Incidence of Bone Metastases and Skeletal-Related Events in Patients With EGFR-Mutated NSCLC Treated With Osimertinib

Anita J W M Brouns et al. JTO Clin Res Rep. .

Abstract

Introduction: Bone metastases are frequent in patients with EGFR-mutated (EGFR+) NSCLC. Skeletal-related events (SREs) are common in these patients; however, no data on SRE in osimertinib-treated patients are reported. We investigated the development of bone metastases and SREs in patients with EGFR+ NSCLC treated with osimertinib.

Methods: This is a retrospective multicenter cohort study that included patients with metastatic EGFR+ NSCLC who were treated with osimertinib between February 2016 and September 2021. Demographics, bone metastases-related outcomes, SREs, treatment efficacy, and overall survival (OS) were collected.

Results: In total, 250 patients treated with osimertinib (43% first line) were included. Of the patients, 51% had bone metastases at initiation of osimertinib. Furthermore, 16% of the patients with bone metastases used bone-targeted agents. Median follow-up from initiation of osimertinib was 23.4 months (95% confidence interval [CI]: 19.9-26.9 mo). During osimertinib treatment, 10% developed new bone metastases or bone progression. Of the patients with bone metastases, 39% had more than or equal to one SREs: 28% developed first SRE before osimertinib treatment, 1% after, and 11% during. Median OS post-bone metastasis was 30.8 months (95% CI: 21.9-39.7). Median OS after first SRE was 31.1 months (95% CI: 15.8-46.5).

Conclusions: Bone metastases and SREs are frequent before and during treatment with osimertinib in EGFR+ NSCLC. Because of these findings and the long OS post-bone metastases, we advocate prescription of bone-targeted agents in these patients and recommend adding bone-specific end points in clinical trials.

Keywords: Bone metastases related outcomes; Bone targeted agents; Lung adenocarcinoma; Solid tumors; Tyrosine kinase inhibitor.

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Figures

Figure 1
Figure 1
Presence of bone metastases. Time frame of development of bone metastases during NSCLC disease course.
Figure 2
Figure 2
Presence of skeletal-related events. (A) Bone metastases during NSCLC disease course. (B) Presence of SRE in patients with bone metastases. (C) Time frame of SRE development in patients with bone metastases during NSCLC disease course. SREs are presented as percentage of the study population with bone metastases, for example, 39 patients have an SRE before initiation of osimertinib. SRE, skeletal-related event.
Figure 3
Figure 3
(A) Overall survival from diagnosis of metastatic NSCLC. Black line: patients with metastatic NSCLC without bone metastases; red dashed line: patients with metastatic NSCLC with bone metastases. (B) Overall survival from initiation of osimertinib. Black line: patients with metastatic NSCLC without bone metastases; red dashed line: patients with metastatic NSCLC with bone metastases. BM−, bone metastases absent; BM+, bone metastases present; CI, confidence interval; HR, hazard ratio; mOS, median overall survival; ref, reference.
See this image and copyright information in PMC

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