148P Neoadjuvant EGFR-TKI combined with chemotherapy improves the complete response rate in operable EGFR-mutant NSCLC patients: A multicenter real-world study

The FLAURA2 study confirmed that EGFR-TKI combined chemotherapy improved the objective response rate of patients with advanced EGFR mutant NSCLC than targeted monotherapy, and the efficacy of neoadjuvant targeted therapy for operable patients was not ideal. Therefore, we aim to evaluate the efficacy and safety of neoadjuvant EGFR-TKI combined with chemotherapy in operable EGFR mutant NSCLC patients. Patients with EGFR mutations receiving neoadjuvant chemotherapy and targeted therapy followed by resection were included in the prospective databases in two high-volume cancer centers. We evaluated the MPR rate, pCR rate, and treatment safety, and performed survival analysis using the Kaplan-Meier curve and Cox regression model. In total, 30 patients were enrolled, most were female (n=19, 63.3%), and the median age was 60 years.10 pts were C-stage II and 20 pts were C-stage III. The majority subtype of EGFR mutation was exon-19 deletion (n=16, 53.3%), followed by the exon-21 L858R mutation (n=11, 36.7%). The most frequent EGFR-TKI was 3rd-generation (n=20, 66.7%), followed by 2nd-generation (n=9, 30.0%), and the regimens of chemotherapy were pemetrexed plus carboplatin. The preoperative TKI exposure duration ranged from 1 month to 11 months. the cycles of neoadjuvant chemotherapy ranged from 1 to 4. Grade 3–4 treatment-related AE rates were 10%. The objective response rate (ORR) was 73.3% (22 / 30), and 23 out of 30 patients achieved down-staging (76.7%). The R0 resection rate was 96.7% (29/30), and 80% was VATS. The pCR rate was 20% (6/30) and the MPR rate was 36.7% (11/30). 22 patients received adjuvant therapy. 5 patients (16.7%) developed relapse (median follow-up, 26.2 mo), and the 2-y DFS rate was 76%. Combining EGFR-TKI with chemotherapy in the preoperative setting could improve pCR and MPR rates of the operable NSCLC patients with EGFR mutations, and this strategy was safe and feasible. Our results need to be validated by future prospective RCT trials.