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Ms Meier is back.
So is her lung cancer.

Probabilities

What is the risk of recurrence in patients with completely resected NSCLC within the first 5 years?

Recurrence and/or death graph
Woman waiting room

With each check-up, I am more afraid of what my doctor will tell me.

Edith Meier*

DOB: 08.02.1959

Diagnoses:

02/23 Three new brain metastases

Oncology history:

03/20Initial diagnosis of NSCLC in left upper lobe
Stadium IB
T2a NO MO
Histology: adenocarcinoma
04/20Status post lobectomy of left upper lobe (R0)

Ms Meier is not an isolated case.

In stage IB-III NSCLC, more than half of the patients suffer a relapse or die within the first 5 years - despite early diagnosis and successful complete resection.1

Woman from back

What if the treatment wasn't enough?
What if I fought for nothing?

Distant metastasis

Where do recurrences in resected NSCLC patients mainly occur?

Edith Meier*

DOB: 08.02.1959

The patient presented as part of her annual follow-up. The patient reported weakness in her left leg and an increasing tendency to fall. Consecutive cranial CT scans revealed 3 new brain metastases with moderate oedema. Further staging (imaging procedures: thoracic CT scan, abdominal CT scan) did not reveal any evidence of local recurrence or further metastases.

A major risk in early NSCLC: distant CNS metastases

In 2 out of 3 patients, recurrence occurs in the form of distant metastases. As in the case of Ms Meier, NSCLC most frequently metastasises to the CNS.2

Cerebral metastasis is largely responsible for an overall poorer prognosis and often impairs the quality of life of those with the disease.3,4

Woman Sad

My cancer is back.
And my strength is gone.

Done enough?

Edith Meier*

DOB: 08.02.1959

Summary and course:
Ms. Meier was diagnosed with stage IB adenocarcinoma in her left upper lobe in 03/2020. She underwent complete resection. After her annual follow-up, a cranial CT scan revealed 3 new brain metastases with moderate oedema.
We immediately initiated therapy with dexamethasone (3x8 mg), which caused the neurological symptoms to disappear completely. The patient was presented to our tumour board, where stereotactic radiation therapy of the metastases was recommended.

Despite successful initial therapy and independent of the use of adjuvant chemotherapy, a significant proportion of patients develop CNS metastases later on, which are difficult to treat on account of the blood-brain barrier.5

Woman with coffee

Show the high relapse risk associated with EGFRm NSCLC the door!

Risk mitigation

Make adjuvant targeted therapy possible - with early molecular testing

Had Ms Meier tested positive for an EGFR mutation (Ex19del or L858R) after her initial diagnosis and had she received adjuvant treatment with osimertinib following complete resection, her chances of being recurrence-free would have been significantly better. The EGFR TKI reduces the relative risk of recurrence by 73% in stages IB-IIIA, independent of prior chemotherapy, as well as significantly reduces the risk of CNS metastases developing.6

Timing for EGFR mutation testing in early-stage NSCLC ***,7–9

Patient pathway
Seize the opportunity using EGFR mutation testing, as recommended in the guidelines, for all suitable patients in the early stages IB-IIIA.7-9
More information about ADJUVANT TAGRISSO® (ADAURA)
  • * Edith Meier is a fictional character.
  • ** The data come from 5 pooled studies involving a total of 4,584 post-surgery patients with stage IB-IIIA NSCLC who received chemotherapy or no chemotherapy.1
  • *** The ESMO and NCCN guidelines recommend the mandatory testing for EGFRm in stage IB-III NCSLC.7,8 ESMO recommends reflexive testing of pre-surgery diagnostic specimens.9

References:

  1. Pignon JP et al. Lung Adjuvant Cisplatin Evaluation: A Pooled Analysis by the LACE Collaborative Group. J Clin Oncol. 2008; 26(21): 3552-3559.
  2. Chouaid C et al. Adjuvant treatment patterns and outcomes in patients with stage IB-IIIA non-small cell lung cancer in France, Germany, and the United Kingdom based on the LuCaBIS burden of illness study. Lung Cancer. 2018; 124: 310-316.
  3. Peters S, Bexelius C, Munk V, et al: The impact of brain metastasis on quality of life, resource utilization and survival in patients with non-small-cell lung cancer. Cancer Treat Rev. 2016;45:139-162.
  4. Taniguchi Y, Tamiya A, Nakahama K, et al: Impact of metastatic status on the prognosis of EGFR mutation-positive non-small cell lung cancer patients treated with first-generation EGFR-tyrosine kinase inhibitors. Oncol Lett 2017; 14:7589-7596.
  5. Andratschke N et al. Optimal management of brain metastases in oncogenic-driven non-small cell lung cancer (NSCLC). Lung Cancer. 2019 Mar;129:63-71.
  6. Herbst RS et al. Adjuvant osimertinib for resected EGFR-mutated stage IB-IIIA NSCLC: updated results from the phase III randomized ADAURA trial. J Clin Oncol. 2023; 41(10):1830-1840
  7. Referenced with the approval of NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for NSCLC V.3.2023. © National Comprehensive Cancer Network, Inc. 2023. All rights reserved. NCCN gives no guarantee of any kind with regard to their content or use and rejects any responsibility for their use in any way. Access on 28/06/2023
  8. Remon J, et al. on behalf of the ESMO Guidelines Committee. Early and locally advanced non-small-cell lung cancer: an update of the ESMO Clinical Practice Guidelines focusing on diagnosis, staging, systemic and local therapy. Annals of Oncology. 2021; 32 (12): 1637–1642. doi: https://doi.org/10.1016/j.annonc.2021.08.1994.
  9. Gosney JR, et al. Pathologist-initiated reflex testing for biomarkers in non-small-cell lung cancer: expert consensus on the rationale and considerations for implementation. ESMO Open 2023. 2023 Aug; https://doi.org/10.1016/j.esmoop.2023.101587

TAGRISSO®
Comp: Osimertinib; 40 mg and 80 mg film-coated tablets; List A. Ind: TAGRISSO is indicated as monotherapy for the adjuvant treatment after complete tumour resection in adult patients with non-squamous, non-small cell lung cancer (NSCLC) with EGFR (epidermal growth factor receptor) exon 19 deletions or exon 21 (L858R) substitution mutations, for the first-line treatment in adult patients with locally advanced or metastatic NSCLC with EGFR exon 19 deletions or exon 21 (L858R) substitution mutations, for the treatment of adult patients with locally advanced or metastatic NSCLC with EGFR‑T790M‑mutation who have progressed on or after EGFR TKI therapy, as well as in combination with pemetrexed and platinum‑based chemotherapy for the first-line treatment of adult patients with locally advanced or metastatic, non-squamous NSCLC whose tumours have EGFR exon 19 deletions or exon 21 (L858R) substitution mutations. Dos: 80 mg once daily in monotherapy as well as in combination with pemetrexed and 4 cycles platinum-based chemotherapy. CI: Hypersensitivity to the active substance or to any of the excipients. Concomitant use of St. John’s Wort. W&P: Interstitial lung disease. Erythema multiforme. QTc interval prolongation. LVEF and cardiomyopathy. Diarrhoea. Age and body weight. IA: Strong CYP3A inducers. CYP3A4 substrates and transporters. ADRs: Very common: diarrhoea, stomatitis, rash, dry skin, paronychia, pruritus, platelet count decreased, leukocytes decreased, lymphocytes decreased, neutrophils decreased, blood creatinine increased. Common: interstitial lung disease, epistaxis, palmar-plantar erythrodysaesthesia syndrome, alopecia, urticaria, blood creatine phosphokinase increased, QTc interval prolongation, cardiac failure, left ventricular ejection fraction decreased, erythema multiforme, skin hyperpigmentation. Uncommon, rare, very rare: see www.swissmedicinfo.ch. Date of revision of the text: December 2023.

Further information: www.swissmedicinfo.ch or AstraZeneca AG, Neuhofstrasse 34, 6340 Baar, Switzerland. www.astrazeneca.ch.

Professionals can request the mentioned references from AstraZeneca AG.