Abstract
BACKGROUND: EGFR-inhibitors are currently not approved for neoadjuvant treatment of resectable EGFR-mutant non-small cell lung cancers (NSCLC). We report a real-world multi-institutional analysis of surgical and pathologic outcomes in patients with resectable EGFR-mutant NSCLC treated with neoadjuvant therapies. METHODS: We identified patients with clinical stage II-IIIB NSCLC with sensitizing EGFR mutations who received neoadjuvant osimertinib and/or platinum-based doublet chemotherapy with intent for definitive surgical resection. Clinicopathologic characteristics and treatment outcomes were annotated. Event-free survival (EFS) was defined from the start of neoadjuvant treatment. RESULTS: We identified 51 patients who received neoadjuvant osimertinib (N = 23, 45 %), chemotherapy alone (N = 18, 35 %), or osimertinib and chemotherapy (N = 10, 20 %). R0 resection rates were 91 % with osimertinib, 72 % with chemotherapy, and 90 % with osimertinib and chemotherapy. Rates of pathologic complete response were 17 % with osimertinib, 0 % with chemotherapy, and 0 % with osimertinib and chemotherapy. Rates of major pathologic response were 44 % with osimertinib, 0 % with chemotherapy, and 10 % with osimertinib and chemotherapy. Pathologic tumor downstaging occurred in 48 % with osimertinib, 44 % with chemotherapy, and 40 % with osimertinib and chemotherapy; pathologic lymph node downstaging occurred in 35 % with osimertinib, 28 % with chemotherapy, and 40 % with osimertinib and chemotherapy. Median follow up time was 19 months. Median EFS was 61 months with osimertinib, 32 months with chemotherapy, and 20 months with osimertinib and chemotherapy. CONCLUSIONS: Pathologic complete responses and major pathologic responses were only observed in patients with EGFR-mutant NSCLC treated with osimertinib. EGFR-inhibitors may play an important role in the preoperative management of EGFR-mutant lung cancer.