OSIREAL - Osimertinib RWE on EGFRm NSCLC in Spain
Study Details
Study Description
Brief Summary
Lung cancer (LC) is the tumor responsible for the highest mortality worldwide. Lung adenocarcinoma is the major subtype of lung cancer and represents the deadliest human cancer, affecting current-, ex-, and even non-smokers.
Osimertinib is indicated as monotherapy for the first-line treatment of adult patients with locally advanced or metastatic NSCLC with activating mutations in the EGFR, for the treatment of adult patients with EGFR T790M mutation-positive locally advanced or metastatic NSCLC, and for the adjuvant treatment of adult patients with NSCLC stages IB-IIIA after complete resection of the tumor that has activating mutations of the EGFR.
The FLAURA trial showed that treatment with osimertinib significantly prolongs PFS and improves overall survival (OS) compared to standard EGFR tyrosine kinase inhibitors.
The results of the ADAURA study showed a reduction in the risk of recurrence or death by 83% in stages II to IIIA, and in 80% in stages IB-IIIA. Additionally, osimertinib demonstrated a highly statistically significant improvement in DFS and HRQoL was maintained.
To date, there are real-world data on osimertinib use in pretreated patients with stages IIIB-IV NSCLC EGFRm/T790M in Spain, obtained from the OSIREX study. However, there are no real-world data on osimertinib either in first-line treatment in locally advanced or metastatic EGFRm NSCLC nor as adjuvant treatment, in early stages of cancer, regarding effectiveness, adherence, treatment exposure and quality of life (QoL), among others, and in particular for the use of osimertinib in subpopulations less represented in pivotal trials as elderly or patients with uncommon EGFR mutations. Furthermore, the duration of treatmenti in real life is also a gap, as it appears to be longer than in clinical trials, which means that there are patients who are treated beyond progression, Therefore, this observational ambispective study based on real-world data aims to provide data on osimertinib use as adjuvant treatment in adult patients diagnosed with stages IB-IIIA EGFRm NSCLC and in first line treatment in patients with locally advanced or metastatic EGFRm NSCLC, in Spain, indications currently marketed in Spain. Specifically, the study will focus on patient characteristics, adherence, treatment exposure, administration, survival, QoL, effectiveness and safety providing insights into osimertinib use in daily practice for patients with EGFRm NSCLC, where there are current evidence gaps.
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Detailed Description
Cancer continues to be one of the leading causes of morbidity and mortality in the world. It is estimated that in the year 2020, approximately 18.1 million new cases of cancer in the world, and that this figure will increase in the next two decades to 27 million. The most frequently diagnosed tumors in the world in 2020 were those of the breast, lung (which occupies the second position), colon and rectum, prostate and stomach, all of them with more than one million cases.
Also, in Spain, cancer is one of the main causes of morbidity and mortality. It is estimated that in 2020 there were 113,054 deaths from cancer in Spain. The number of cancers diagnosed in Spain in 2022 is estimated to reach 280,100 cases according to REDECAN calculations, which represents a slight increase compared to previous years. Lung cancer (LC) is the tumor responsible for the highest mortality worldwide. After prostate cancer, it is the second most common cancer in men and, after breast cancer, in women. Lung adenocarcinoma is the major subtype of lung cancer and represents the deadliest human cancer, affecting current-, ex-, and even non-smokers.
The most frequently diagnosed cancers in Spain in 2023 will be those of the colon and rectum, breast, lung, prostate, and urinary bladder. Lung cancer is a very common cancer in Spain, however, due to its high mortality, its prevalence at five years is relatively low.
Approximately 30% of patients with non-small cell lung cancer (NSCLC) have early-stage disease that is treated with surgery. A high percentage of these patients relapse and die, so patients receive postoperative adjuvant systemic chemotherapy to increase their survival. However, the benefits of this strategy are modest. NSCLC is often associated with druggable molecular alterations that drive lung carcinogenesis. EGFR tyrosine kinase inhibitors (TKIs) have been included in treatment paradigms with the aim of improving the outcome of adjuvant therapy in patients with completely resected, EGFR mutation-positive (EGFRm+) disease.
The standard of care for patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI)-sensitizing mutations is treatment with a first-generation or second-generation EGFR-TKI such as gefitinib, erlotinib, or afatinib. Treatment with EGFR-TKIs in this patient population has extended progression-free survival relative to chemotherapy as initial therapy.
Osimertinib is indicated as monotherapy for the first-line treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with activating mutations in the epidermal growth factor receptor (EGFR), for the treatment of adult patients with EGFR T790M mutation-positive locally advanced or metastatic NSCLC, and for the adjuvant treatment of adult patients with NSCLC stages IB-IIIA after complete resection of the tumor that has activating mutations of the EGFR (exon 19 deletion or exon 21 substitution (L858R)).
The FLAURA trial showeds that treatment with osimertinib significantly prolongs progression-free survival (PFS) compared to EGFR TKI comparator (median 18.9 months and 10.2 months, respectively, HR=0.46, 95% CI: 0.37, 0.57; P<0.0001) (5) and improves overall survival (OS) (HR=0.799 [95.05% CI: 0.641, 0.997]) compared to standard EGFR tyrosine kinase inhibitors (TKIs), in patients with EGFR mutation-positive advanced non-small-cell lung cancer (NSCLC). A greater proportion of patients treated with osimertinib were alive at 12, 18, 24 and 36 months (89%, 81%, 74% and 54% respectively) compared to patients treated with EGFR TKI comparator (83%, 71%, 59% and 44% respectively).
The results of the ADAURA trial showed that adjuvant treatment with osimertinib reduced the risk of recurrence or death by 83% in stages II to IIIA, and in 80% in stages IB-IIIA, compared with placebo, in patients with NSCLC with completely resected stage IB to IIIA disease and confirmed EGFR mutation. Additionally, osimertinib demonstrated a highly statistically significant improvement in disease free survival (DFS) and HRQoL was maintained. A DFS benefit favouring osimertinib over placebo was seen across all prespecified subgroups, including those based on disease stage, EGFR sensitizing mutation, ethnicity and receipt of adjuvant chemotherapy. Furthermore, the DFS benefit with osimertinib was similar in patients who had or had not received chemotherapy.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
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| Cohort 1 Patients diagnosed with locally advanced or metastatic NSCLC with activating EGFR mutations that received first line treatment with osimertinib (FLAURA regimen). |
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| Cohort 2 Patients with stage IB-IIIA NSCLC after complete tumour resection that has activating mutations in the EGFR (deletion of exon 19 or substitution of exon 21 [L858R]) that received adjuvant treatment with osimertinib (ADAURA regimen). |
Outcome Measures
Primary Outcome Measures
- To evaluate the effectiveness of osimertinib in terms of median OS in patients with locally advanced or metastatic EGFRm NSCLC (Cohort 1). [From start of osimertinib treatment to death, assesed up to 6 years]
Overall survival (OS) measured as median time from start of osimertinib treatment to death and rates at months 6, 12 and 18 (cohort 1), and 2, 3, 4 and 5 years (both cohorts) after starting osimertinib.
- To evaluate the effectiveness of osimertinib in terms of 4-year rwDFS rate in patients with stages IB-IIIA EGFRm NSCLC (Cohort 2). [4 years after the start of osimertinib]
Real World Disease Free Survival (rwDFS) defined as the time from start of osimertinib until the date of disease recurrence or death from any cause in the absence of disease recurrence. The primary measure of interest is the 4-year real world disease-free survival rate and corresponding 95% confidence interval. - 4-year real world disease-free survival rate for Cohort 2. (i.e., percentage of patients with clinical or radiological recurrence 4 years after the start of osimertinib treatment, as evaluated by the treating physician according to standard clinical practice).
Secondary Outcome Measures
- To evaluate the effectiveness of osimertinib in terms of rwPFS in patients with locally advanced or metastatic EGFRm NSCLC (Cohort 1) and in terms of rwDFS rates and OS in patients with stages IB-IIIA EGFRm NSCLC (Cohort 2) treated with Osimertinib. [From start of osimertinib to clinical/radiological progression or death from any cause, whichever came first, assesed up to 6 years]
Real World Progression-Free Survival (rwPFS) defined as the time from start of osimertinib treatment to clinical/radiological progression or death from any cause, in the basence of progression, as evaluated by the treating physician according to standard clinical practice. The primary measure of interest is the median and corresponding 95% confidence interval.
- To describe changes in osimertinib treatment administration for EGFRm NSCLC. [During osimertinib treatment, assesed up to 6 years in cohort 1 and up to 3 years in cohort 2.]
Frecuency of dose changes, measured as interrumptions and reductions and their reasons
- To describe healthcare resource use (HCRU) during the osimertinib treatment for EGFRm NSCLC in real life. [During osimertinib treatment, assesed up to 6 years in cohort 1 and up to 3 years in cohort 2.]
Healthcare resources used in relation to EGFRm NSCLC and its treatment assessed by the mean number of hospitalizations (and their duration) and outpatient, pharmacy and emergency unit visits related to EGFRm NSCLC and specific tests/procedures performed.
- To describe therapies received before and after osimertinib treatment progression or relapse [Before and after osimertinib treatment, assesed up to 6 years in cohort 1 and up to 3 years in cohort 2.]
Therapies received during adjuvant and neoadjuvant: active drug, dose, mode of administration, duration, interruption. Surgery: type, outcome (R0-R1) Number and type of other treatments received during osimertinib administration. Number and types of therapies received after osimertinib treatment progression or relapse
- To describe the safety profile of osimertinib in a real-world setting. [During osimertinib treatment, assesed up to 6 years in cohort 1 and up to 3 years in cohort 2]
Events of clinical interest (ECIs) (start and end date, causality, impact on treatment (i.e., requires dose reduction or interruption), adverse events that lead to osimertinib dose changes, interruptions, or permanent discontinuation, and AEs that are considered serious (including fatal events).
- To describe duration of osimertinib treatment in real life for EGFRm NSCLC [During osimertinib treatment, assesed upt to 6 years in cohort 1, and up to 3 years in cohort 2]
Median duration of treatment measured as time from start of osimertinib treatment to discontinuation of treatment or death and discontinuation rates at 6 montly intervarls
Other Outcome Measures
- To describe the effectiveness of osimertinib monotherapy in patients with locally advanced or metastatic EGFRm NSCLC (Cohort 1) who have uncommon EGFR mutations. [OS from start of osimertinib treatment to death and rates at months 6, 12, 18, and 2, 3, 4, 5 years after starting osimertinib.]
rwPFS: measured as median time from start of osimertinib treatment to radiological/clinical progression or death in real world. Overall survival: measured as median time from start of osimertinib treatment to death and rates at months 6, 12 and 18, and 2, 3, 4 and 5 years after starting osimertinib.
- To describe adherence of osimertinib monotherapy in patients with locally advanced or metastatic EGFRm NSCLC (Cohort 1) who have uncommon EGFR mutations. [During osimertinib treatment, assesed up to 6 years]
Mean percentae covered (PDC) and percentage of patients with PDC ≥ 80% while receiving osimertinib
- To describe the safety of osimertinib monotherapy in patients with locally advanced or metastatic EGFRm NSCLC (Cohort 1) who have uncommon EGFR mutations. [During osimertinib treatment assesed up to 6 years]
-AEs that lead to osimertinib dose changes, interruptions, or permanent discontinuation, ECIs during osimertinib treatmentand AEs that are considered serious (including fatal events).
- To describe the use of healthcare resources of osimertinib monotherapy in patients with locally advanced or metastatic EGFRm NSCLC (cohort 1) who have uncommon EGFr mutations [During osimertinib treatment assesed up to 6 years]
Healthcare resources used in relation to EGFRm NSLC and its treatment
- To evaluate patient reported outcomes and experience measures (PROMs and PREMs) in EGFRm NSCLC patients treated with Osimertinib as adjuvant treatment (only applicable to cohort 2). [SATMED-Q, SF-36: reported at study inclusion and every 6 months thereafter during the prospectiv follow-ip on osimertinib treatment, an average of 3 years.]
Scores on the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q). Scores on the SF-36: 36-Item Short Form Survey3-level 5-dimension EuroQol questionnaire. The standard version of SF-36 has a recall period of four weeks. Note: these questionnaires will only be collected for patients in cohort 2 who have initiated osimertinib treatment within a maximum period of 12 months before patient inclusion in the study.
- To describe the adherence of patients with EGFRm NSCLC treated with osimertinib under real-world conditions. [ADAQ: reported at study inclusion and weekly thereafter during prospective follow-iup on osimertinib treatment, an average of 3 yeards]
Adherence will be measured weekly using the Adelphi Adherence Questionnaire (ADAQ) through a mobile App managed by the company Naru Intelligence. Note: Only applicable to patients in cohort 2 who have started osimertinib treatment within a maximum period of 12 months before patient inclusion in the study.
- To asess factors associated with outcomes (rwTTD: Real World Time to Discontinuation and rwTFST: Real World time to first subsequent therapy) among patients in cohort 1 and cohort 2 [rwTTD from treatment initation to time to discontinuation; rwTFST from treatment initiation until the start of subsequent therapy or death. Both assesed up to 6 years in cohort 1 and up to 3 years in cohort 2]
rwTTD defined as the time from the start of osimertinib treatment to the end of the treatment. rwTFST defined as the time from treatment initiation until the start of subsequent therapy or death.
- To describe the effectiveness of osimertinib monotherapy in elderly patients (>65 and >75 years) with locally advanced or metastatic EGFRm NSCLC (Cohort 1). [During osimertinib treatment assesed upt to 6 years.]
rwPFS, measured as median time from start of osimertinib treatment to clinical/radiological progresion or death. Overall survival:measured as median time from start of osimertinib treatment to death and rates at months 6, 12 and 18, and 2, 3, 4 and 5 years after starting osimertinib.
- To describe the adherence of osimertinib monotherapy in elderly patients (>65 and >75 years) with locally advanced or metastatic EGFRm NSCLC (Cohort 1). [From start of osimertinib treatment assesed up to 6 years]
Mean percentage of days covered (PDC) and percentage of patients with PDC ≥80% while receiving osimertinib.
- To describe the safety of osimertinib monotherapy in elderly patients (>65 and >75 years) with locally advanced or metastatic EGFRm NSCLC (Cohort 1). [During osimertinib treatment assesed up to 6 years]
- AEs that lead to osimertinib dose changes, interruptions, or permanent discontinuation, and ECIs during osimertinib treatment and AEs that are considered serious, including fatal events.
- To describe the use of healthcare resources of osimertinib monotherapy in elderly patients (>65 and >75 years) with locally advanced or metastatic EGFRm NSCLC (Cohort 1). [During osimertinib treatment assesed up to 6 years]
Uso of healthcare resources used in relation to EGFRm NSCLC and its treatment.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Female or male patients, treated with osimertinib
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Age ≥ 18 years at starts of osimertinib treatment (i.e., index date).
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Patients histologically diagnosed with EGFRm NSCLC (before index date):
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Patients with first-line treatment with EGFRm locally advanced or metastatic NSCLC, not amenable to curative surgery or radiotherapy (Cohort 1).
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Patients with stage IB-IIIA after complete tumor resection (Cohort 2).
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Provision of informed consent (for alive patients). Deceased patients who met the selection criteria when they started treatment with osimertinib could also be included in the study.
Exclusion Criteria:
- Osimertinib treatment administration in a clinical trial setting.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Luis Ángel Leon Mateos | Santiago de Compostela | Galicia | Spain |
Sponsors and Collaborators
- AstraZeneca
Investigators
- Principal Investigator: Delvys Rodriguez, Hospital Universitario Insular de Gran Canaria
- Principal Investigator: Ana Cardeña, University Hospital of the Nuestra Señora de Candelaria
- Principal Investigator: Martín Lázaro, Hospital Álvaro Cunqueiro
- Principal Investigator: Luis Angel León Mateos, Complejo Hospitalario Universitario Santiago de Compostela
- Principal Investigator: Rosario García, Hospital A Coruña
- Principal Investigator: Ana Laura Ortega, Hospital Universitario Medico Quirúrgico Ciudad de Jaén
- Principal Investigator: Silvia Sequero, Hospital Universitario San Cecilio
- Principal Investigator: Angel Artal, Hospital Miguel Servet
- Principal Investigator: Aitor Azkarate, Hospital Son Espases
- Principal Investigator: Marta López-Brea, Hospital Universitario Marqués de Valdecilla
- Principal Investigator: Rafael López, Hospital Clínico Universitario de Valladolid
- Principal Investigator: Soledad Medina, Hospital de Leon
- Principal Investigator: Alberto Rodrigo, Hospital Universitario Arnau de Vilanova
- Principal Investigator: Edurne Arriola, Hospital del Mar
- Principal Investigator: Joaquim Bosch, Hospital Dr Josep Trueta (ICO Girona)
- Principal Investigator: Laia Vila, Corporacion Parc Tauli
- Principal Investigator: Jose Luis González Larriba, Hospital Universitario Clínico San Carlos
- Principal Investigator: José Miguel Sánchez Torres, Hospital Universitario La Princesa
- Principal Investigator: Rosa Alvarez, Hospital General Universitario Gregorio Marañón
- Principal Investigator: Silverio Ros, Hospital Clínico Universitario Virgen de la Arrixaca
- Principal Investigator: Bartomeu Massuti, Hospital General Universitario de Alicante
- Principal Investigator: Oscar Juan, Hospital Universitari i Politècnic La Fe de Valencia
- Principal Investigator: Reyes Bernabé, Hospitales Universitarios Virgen del Rocío
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- D5162R00034