To report the final analysis of time-on-treatment (TOT) and overall survival (OS) in patients with advanced-stage EGFR+ non-small-cell lung cancer (NSCLC) who received sequential afatinib and osimertinib and to compare the outcomes with other second-line regimens (comparator group)....The median OS in the osimertinib group was 54.3 months (95%CI:46.7-61.9), much longer than that in the comparator group. In patients who received osimertinib, the OS was longest with Del19+ (median 59.1, 95% CI:48.7-69.5).

Treatment-naive patients with stage IV NSCLC harboring an activating EGFR mutation (L858R or exon-19 deletion) were enrolled....The ORR was 69.6% (95% CI, 54.2–82.3%; 2 patients with a complete response, 30 with a partial response, and 12 with stable disease)....subgroup analysis according to type of EGFR mutation revealed that the 26 patients with an exon-19 deletion had a 12-month PFS probability of 58.6% (95% CI, 36.8–75.2%) and median PFS of 23.6 months (95% CI, 6.3 months–not reached), compared with corresponding values of 84.7% (95% CI, 59.7–94.8%) and 20.8 months (95% CI, 14.4 months–not reached) for the 20 patients with an L858R point mutation (Fig. 2C)...alternating therapy with osimertinib and afatinib demonstrated a encouraging efficacy and safety profile with a median PFS of 21.3 months...

...we investigated the total TOT along with four treatment options starting from first-line afatinib treatment to various subsequent treatments, including osimertinib and cytotoxic chemotherapy....Regarding the subtype of EGFR mutations, the median total TOTs were 26.40 months (95% CI: 24.08–29.34 months), 20.60 months (95% CI: 19.91–26.45 months), 11.40 months (95% CI: 8.61–16.33 months), and 15.40 months (95% CI: 5.22–18.00 months) for Del19, L858R, uncommon mutations, and compound mutations, respectively (P<0.001).