Clinical Outcomes, Treatment and Testing Patterns in Patients with Advanced Non-Small Lung Cell Cancer with Epidermal Growth Factor Receptor Mutations: Results of the Romanian Cohort From a Multi-national Retrospective Chart Review (REFLECT)

Author(s) :

Mircea Dediu1, Aurelia Alexandru2, Cristina Ligia Cebotaru3, Petra Curescu4, Polixenia Iorga5, Bogdan Gafton6, Mihai Marinca6, Amedeia Nita7, Mihaela Pașca Feneșan8, Adrian Udrea9, Roxana Lupu10, Gabriela Teodorescu10, Tudor E. Ciuleanu3

1Sanador Oncology Center, Bucharest, Romania;

2Oncology Institute “Prof. Dr. Alexandru Trestioreanu” Bucharest, Romania;

3Oncology Institute “Prof. Dr. Ion Chiricuță” Cluj-Napoca, Romania;

4City Hospital Timișoara, Romania;

5University Emergency Hospital Bucharest, Romania;

6Regional Institute of Oncology Iași, Romania;

7City Hospital Ploiești, Romania;

8Oncohelp Medical Center Timișoara, Romania;

9Medisprof Cancer Center Cluj-Napoca, Romania;

10AstraZeneca Pharma, Bucharest, Romania

Corresponding author: Mircea Dediu, Email:

Published: Volume II, Issue 2, December 2022, , , - DOI: 10.53011/JMRO.2022.02.05, 27-37

Open Access

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December 1, 2022 0 Comments


Background: REFLECT was a retrospective, non-interventional study conducted in eight countries, including eleven sites from Romania, on patients with advanced stage non-small cell carcinoma (NSCLC).
Aim: To characterize clinical outcomes, treatments and the proportion of T790M EGFR mutation testing in patients with advanced non-small cell lung cancer (NSCLC) receiving first- or second-generation (1G/2G) epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs ) as first-line (1L) treatment in the Romanian cohort of an international study.
Methods: Comprehensive data were retrieved from the medical records of ninety patients with EGFR-mutated advanced NSCLC treated with 1G/2G EGFR TKIs between January 2015 and June 2018. All analyses are descriptive.
Results: The median age at lung cancer diagnosis in the Romanian cohort was 67.5 years, with 68% females. The distribution of EGFR TKIs was 50% erlotinib, 31% afatinib, and 19% gefitinib. First line treatment was stopped in 76 (84%) patients due to progression (79%), toxicities (3%), the patient’s decision (1%) or surgery (1%). The median progression- free survival on 1L treatment was 12.0 months (95% CI 10.3-15.6), and the median overall survival from the start of first line therapy was 26.4 months (95% CI 22.4-34.2). EGFR T790M mutation testing was performed on 69% of patients at the time of progression on 1L therapy, with 57% of patients testing positive. Second-line (2L) therapy was started in 63% of patients discontinuing 1L therapy. Third-line treatment was started in 50% of patients discontinuing 2L treatment.
Conclusion: Survival results mirrored those of randomized trials. The suboptimal T790M testing rate (69%) underlines the importance of reflex testing procedures, while attrition rates on 1L (26%) emphasize the need for an upfront selection of the most effective treatments.

Figure 1. Reasons to discontinue 1L EGFR TKI, 2L and 3L in the Romanian cohort.
*The count excludes deceased patients in each line. Due to rounding, percentages may not always be 100%.
Note: The patient discontinuing 1L from unknown reasons started a new therapy line without documented progression, which is considered a per-protocol event.
Figure 2A. Survival outcomes on 1L 1G/2G EGFR TKI therapy: real-world progression free survival (rwPFS)
Figure 2 B. Survival outcomes on 1L 1G/2G EGFR TKI therapy overall survival (OS)
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