Efficacy analysis of immunotherapy‑based combinations for patients with EGFR‑mutant advanced non‑small cell lung cancer after TKI failure

Treatment options for epidermal growth factor receptor (EGFR)‑mutant advanced non‑small cell lung cancer (NSCLC) following tyrosine kinase inhibitor (TKI) failure are limited, and platinum‑based chemotherapy remains the main treatment. The development of effective immunotherapy for this disease has been challenging. In the present study, 37 patients with EGFR‑mutant advanced NSCLC who were treated with programmed cell death‑1 (PD‑1) inhibitor‑based combinations after TKI failure were reviewed. The total cohort had a median progression‑free survival (mPFS) of 5.2 months (95% CI, 4.077‑6.323 months) and a median overall survival (mOS) of 18.3 months (95% CI, 12.932‑23.668 months). Patients with Eastern Cooperative Oncology Group performance‑status (ECOG‑PS) scores of 0 or 1 had longer mPFS than those with ECOG‑PS scores of 2 (5.4 vs. 2.4 months; P=0.006). In addition, a PFS benefit was observed in patients with EGFR T790M‑negative compared with EGFR T790M‑positive tumors (mPFS 6.2 vs. 4.4 months; P=0.041). Patients treated with immunotherapy‑based combinations as a front‑line therapy had a longer mPFS than those in which the combinations were used as a late‑line therapy (6.2 vs. 2.4 months; P<0.001). PD‑1 inhibitor combined with chemotherapy and bevacizumab did not show a clear advantage over PD‑1 inhibitor combined with chemotherapy alone (mPFS, 6.2 vs. 4.4 months; P=0.681), although it resulted in an improved overall response rate (ORR) and disease control rate. Notably, the 7 patients with a programmed cell death ligand‑1 (PD‑L1) tumor proportion score of ≥50% had an ORR of 100% and an mPFS of 8.3 months. Therefore, it is suggested that PD‑1 inhibitor‑based combinations should be a priority treatment option in selective populations, such as those with low ECOG‑PS scores, T790M‑negative status or high PD‑L1 expression in EGFR‑mutant NSCLC after TKI failure. The use of immunotherapy and chemotherapy in combination with antiangiogenic agents appears to be a promising combination therapy for such patients.