Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Real-World EGFR Tyrosine Kinase Inhibitor Outcomes in Advanced NSCLC: A Single-Centre Audit With Focus on Elderly Patients (141171)

Ahmed Shouman 1 , Connor O'Leary 1
  1. Department of Medical Oncology, Mater Hospital Brisbane, Brisbane, QLD, Australia

Background: EGFR TKI trials in advanced NSCLC (EURTAC, FLAURA) enrolled predominantly younger patients (median age 62–65 years), with overall survival (OS) of 38.6 months for Osimertinib (3rd Generation EFGR-TKI) vs.  31.8 months for Erlotinib (1st Generation EGFR-TKI)1,2, leaving efficacy and tolerability data limited in elderly populations. We report real-world outcomes from a single-centre retrospective audit with a focus on patients aged ≥70.

Methods: All patients with EGFR-mutated advanced NSCLC commencing TKI therapy at Mater Hospital Brisbane were audited (April 2014 to January 2026). Demographics, treatment modality (Erlotinib-only, Osimertinib-only, sequential Erlotinib→Osimertinib), dose modifications, discontinuation, and OS from TKI initiation to death or last follow-up were extracted from medical records.

Results: 57 patients were identified; 4 excluded due to insufficient follow up data. Of the 53 patients (74% female; median age 72 years, IQR 63–80.5; 83% Stage IV; 39% Exon 19 deletion, 39% L858R), median follow-up was 21.4 months. Overall median OS was 27.8 months (IQR 16.0–51.9). Treatment median OS: Erlotinib-only 31.1 months (n=16), sequential Erlotinib to Osimertinib 40.0 months (n=14), Osimertinib-only not reached (n=16; 56% ongoing, data immature). Dose reductions occurred in 51% overall (Erlotinib-only 62.5%; Osimertinib-only 25.0%). Patients aged ≥70 years (n=33) had median OS 27.0 months, 55% requiring dose reduction, supporting expected TKI tolerability. Patients aged ≥80 years (n=13) had median OS 27.0 months with approximately 50% requiring dose reduction. Progression drove 64% of discontinuations; and toxicity drove 13% of discontinuations. Median OS was 36.7 months for Exon 19 deletion versus 20.9 months for L858R.

Conclusion: In this real-world cohort with median age exceeding trial populations by approximately a decade, EGFR-TKI outcomes were broadly consistent with landmark trials. Sequential therapy was associated with prolonged OS, consistent with real-world evidence3. High dose reduction rates, particularly with Erlotinib, supported durable responses, supporting TKI use in elderly patients underrepresented in trials.

  1. 1. Ramalingam SS, Vansteenkiste J, Planchard D, et al. Overall Survival with Osimertinib in Untreated, EGFR-Mutated Advanced NSCLC. N Engl J Med. 2020;382(1):41-50. doi:10.1056/NEJMoa1913662
  2. 2. Rosell R, Carcereny E, Gervais R, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2012;13(3):239-246. doi:10.1016/S1470-2045(11)70393-X
  3. 3. Huang YH, Tseng JS, Hsu KH, et al. The impact of different first-line EGFR-TKIs on the clinical outcome of sequential osimertinib treatment in advanced NSCLC with secondary T790M. Sci Rep. 2021;11(1):12084. Published 2021 Jun 8. doi:10.1038/s41598-021-91657-7