LBA2_PR - EGFR mutation testing and oncologist treatment choice in advanced NSCLC: Global trends and differences

Date 17 April 2015
Event ELCC 2015
Session ESMO-IASLC Best Abstracts
Topics Bioethics, Legal, and Economic Issues
Non-Small-Cell Lung Cancer, Metastatic
Presenter James Spicer
Citation Annals of Oncology (2015) 0 (0): 1-8. 10.1093/annonc/mdv128
Authors J. Spicer1, B. Tischer2, M. Peters3
  • 1Research Oncology Offices, Guy's Hospital, SE1 9RT - London/UK
  • 2Germany, Kantar Health, D-80687 - München/DE
  • 3Respiratory Medicine, Concord Repatriation General Hospital, Sydney/AU

Abstract

Aim/Background

IASLC guidelines recommend EGFR mutation testing should be performed at diagnosis of advanced NSCLC (except for SCC) and results should guide treatment decisions. This is important as recent data has shown that matching mutations to specific TKI treatment can improve overall survival (OS). Our aim was to assess the prevalence of mutation testing, attitudes and barriers to testing, and how results affect choice of therapy.

Methods

We conducted an online representative survey of 562 oncologists in 10 countries (Canada, France, Germany, Italy, Japan, South Korea, Spain, Taiwan, UK and USA) between December 2014 and January 2015.

Results

Oncologists reported that EGFR mutation testing was requested prior to first line therapy in 81% of stage IIIb/IV NSCLC patients. Separate from histology, the main reasons for not testing were insufficient tissue, poor performance status (PS) and long turnaround time. PS rarely prevented testing in Asia, compared to North America and Europe. Mutation test results were available before administration of first line therapy in 77% of patients who were tested, with significant differences between countries (range: 51% in France to 89% in Japan; p < .001). 80% of patients with mutations (M+) were treated with TKIs (range: 60% in Canada to 91% in Taiwan). 23% of oncologists do not consider EGFR mutation subtypes in making treatment decisions. In contrast, 49% reported that their decision, including specific TKI selection, is affected by the mutation detected. 75% of oncologists stated that a clinically relevant increase in OS is very important when choosing a first line therapy for EGFR M+ NSCLC.

Conclusions

There is incomplete implementation of guidelines for identification and treatment of EGFR M+ NSCLC. Practices vary between countries and regions. Simple barriers such as timely delivery of test results should be addressed. The reasons for many EGFR M+ patients in some countries still receiving first line chemotherapy need to be understood, especially as recent data shows OS benefit with specific TKI treatment matched to mutation type. Oncologist education and closer guideline concordance should improve outcomes.

Disclosure

J. Spicer: I have received payments not exceeding the cost of research for clinical trials funded by Boehringer Ingelheim, served on advisory boards, and received speaker fees from the company.

B. Tischer: I do not have any personal financial interest in products or processes involved in the research which was performed by Kantar Health and funded by a pharmaceutical company.

M. Peters: I do not have any personal financial interest in products or processes involved in the research. I have previously received honoraria from Boehringer Ingelheim for development and delivery of CME in unrelated therapy areas.