Non-small-cell lung cancer (NSCLC) harboring driver mutation (EGFR mutation or ALK translocations) with clinical characteristics and management in a real-life setting: a retrospective observational multicenter case series study

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Aim: Lung cancer is a leading cause of cancer-related mortality. The most common type of lung cancer is Non-small-cell lung cancer (NSCLC). Molecular targeting drugs are used in the treatment of patients with metastatic NSCLC who have a driver mutation. In this study, we aimed to investigate the relationship between the selected treatment modality in the first line setting, patients characteristics and outcomes on NSCLC patients who had driver mutations. Material and Method: We designed this retrospective study to analyze the effect of the treatment line of tyrosine kinase inhibitors on survival parameters and disease prognosis in NSCLC patients. We enrolled 62 patients with NSCLC who had driver mutations from three cancer centers; Şanlıurfa Research and Training Hospital, Başkent University, and Acıbadem Mehmet Ali Aydınlar University medical oncology departments. Results: Median age was 62 years old (range 30-81). There were 45 (71.4%) and 18 (28.6%) patients with EGFR mutation and EML4-ALK fusion gene rearrangement, respectively. Out of 45 EGFR mutant patients, 22 (34.9%) patients had exon 19 deletion and other 16 (25.4%) patients had exon 21 mutation. Median overall survival (OS) and progression free survival (PFS) was 31 and 9 (95% CI, 5.4-12.6) months, respectively. Univariate statistical analysis failed to show significant difference between EGFR mutation positive and FISH-ALK positive patients regarding OS and PFS (p:0.33). Among patients with EGFR mutation, survival times for patients with exon 19 deletions were statistically significantly higher than those with exon 21 mutations (p:0.02). The overall survival time of oligometastatic patients was statistically significantly higher than the other patients (p:0.001). The PFS of patients who received tyrosine kinase inhibitor in first-line treatment was statistically significantly higher than patients using chemotherapy in first line setting. (14 months vs 5 months) (p:0.01) Conclusion: This study showed that treatment preference in favor of tyrosine kinase inhibitors in first line setting produce fairly good outcomes in metastatic NSCLC patients who had driver mutations.