Patients with BIM-del had a poor objective response rate compared to those without (29% vs. 57%, P = 0.012). BIM-del was associated with shorter progress free survival (PFS) and overall survival (OS). (PFS, 8.3 vs. 10.4 months, P = 0.042; OS, 14.8 vs. 23.4 months, P = 0.005)....BIM-del was associated with inferior efficacy and may serve as a negative predictive biomarker to osimertinib in EGFR T790M NSCLC patients.