393MO - Evaluating medical oncology outcomes (EMOO) in Asia study: Molecular testing, treatment patterns and outcome of patients with stage IV non-squamous non-small cell lung cancer

Background

The EMOO in Asia Study established a clinical annotated population-based registry of lung cancer in a collaboration between ESMO, the International Agency for Research on Cancer, and partner institutions in Indonesia, Malaysia and Singapore and Thailand.

Methods

A retrospective study was conducted based on incident lung cancer cases diagnosed between 2017 – 2019 in Lampang (Thailand), Penang (Malaysia), and Yogyakarta (Indonesia) and a clinical case series obtained from the National Cancer Center in Singapore. Tumour and clinical information were abstracted by chart review according to a predefined study protocol.

Results

Among 2,962 lung cancer cases with a specified pathological diagnosis (87%), the largest proportion of patients had non-squamous NSCLC (76%). For cases with staging information (92.1%), the majority presented with metastatic disease (71%). Overall, rates for molecular testing in the 1,528 patients with stage IV non-squamous NSCLC were 67.0% for EGFR, 42% for ALK, 39% for ROS1, 8% for BRAF and 36% for PD-L1. Among these patients, first line systemic treatment included chemotherapy (26%), targeted therapy (36%), and immunotherapy (6%), with 31% of patients without a record of antitumor treatment. The respective actuarial 1-year survival was 48%, 77%, 68% and 12%. The rates of EGFR mutation testing in Lampang, Penang, Yogyakarta and Singapore was 14%, 59%, 73% and 97%, respectively. Of the patients tested, 58% had EGFR mutations detected. The actuarial 1-year survival was 77% for patients with EGFR mutations and received targeted therapy, 36% for patients tested positive but did not receive target treatment and 44% without detectable EGFR mutations. Molecular testing and the proportion of patients receiving treatment were highly heterogenous between the regions.

Conclusions

Molecular testing rates was heterogenous and survival outcomes varied depending on targeted therapy status and access to treatment. An understanding of testing and treatment factors may improve patient access to optimal treatment.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

ESMO and IARC.

Funding

Foundation or academic group WITH funding from a pharma, biotech, or other commercial company - AstraZeneca, Roche, Novartis.

Disclosure

R. Stahel: Financial Interests, Personal, Invited Speaker: Amgen; Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Invited Speaker: Blueprint; Financial Interests, Personal, Invited Speaker: BMS; Financial Interests, Personal, Invited Speaker: Boehringer Ingelheim; Financial Interests, Personal, Invited Speaker: GSK; Financial Interests, Personal, Invited Speaker: MSD; Financial Interests, Personal, Invited Speaker: Novartis; Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Advisory Board: BMS; Financial Interests, Personal, Advisory Board: Boehringer Ingelheim; Financial Interests, Personal, Advisory Board: GSK; Financial Interests, Personal, Advisory Board: MSD; Financial Interests, Personal, Advisory Board: Pfizer; Financial Interests, Personal, Advisory Board: Roche; Financial Interests, Personal, Advisory Board: Sandoz; Financial Interests, Personal, Advisory Board: Seattle Genetics; Financial Interests, Personal, Advisory Board: Takeda; Financial Interests, Institutional, Other: AstraZeneca; Financial Interests, Institutional, Other: BMS; Financial Interests, Institutional, Other: Daiichi Sankyo; Financial Interests, Institutional, Other: Celgene; Financial Interests, Institutional, Other: Ipsen; Financial Interests, Institutional, Other: Janssen; Financial Interests, Institutional, Other: Mirati; Financial Interests, Institutional, Other: MSD; Financial Interests, Institutional, Other: Novartis; Financial Interests, Institutional, Other: Pfizer; Financial Interests, Institutional, Other: Pierre Fabre; Financial Interests, Institutional, Other: Roche. R. Kanesvaran: Financial Interests, Institutional, Invited Speaker: Astellas; Financial Interests, Institutional, Invited Speaker: Johnson and Johnson; Financial Interests, Institutional, Advisory Board: Johnson and Johnson; Financial Interests, Institutional, Advisory Board: Pfizer; Financial Interests, Institutional, Invited Speaker: Ipsen; Financial Interests, Institutional, Advisory Board: Ipsen; Financial Interests, Institutional, Advisory Board: Amgen; Financial Interests, Institutional, Invited Speaker: Amgen; Financial Interests, Institutional, Advisory Board: BMS; Financial Interests, Institutional, Invited Speaker: BMS; Financial Interests, Institutional, Advisory Board: MSD; Financial Interests, Institutional, Invited Speaker: MSD; Financial Interests, Institutional, Invited Speaker: Novartis; Financial Interests, Institutional, Advisory Board: Bayer; Financial Interests, Institutional, Advisory Board: AstraZeneca; Financial Interests, Institutional, Invited Speaker: AstraZeneca; Financial Interests, Institutional, Advisory Board: Ferring; Financial Interests, Institutional, Invited Speaker: Sanofi; Financial Interests, Institutional, Research Grant: Sanofi; Financial Interests, Institutional, Research Grant: Eisai; Financial Interests, Institutional, Research Grant: Johnson and Johnson; Non-Financial Interests, Personal, Leadership Role, Past President: Singapore Society of Oncology; Non-Financial Interests, Personal, Leadership Role, President: SIOG; Non-Financial Interests, Personal, Leadership Role, Vice Chairman: Singapore Cancer Society; Non-Financial Interests, Personal, Leadership Role, Medical Advisory Board Member: International Kidney Cancer Coalition. N. Prasongsook: Financial Interests, Personal, Advisory Board: Roche (Thailand); Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Advisory Board: Novartis; Financial Interests, Personal, Invited Speaker: Bristol Myers Squibb; Financial Interests, Personal, Invited Speaker: Pfizer. S. Peters: Financial Interests, Institutional, Advisory Board: Vaccibody; Financial Interests, Institutional, Advisory Board: Takeda; Financial Interests, Institutional, Invited Speaker: Takeda; Financial Interests, Institutional, Advisory Board: Seattle Genetics; Financial Interests, Institutional, Advisory Board: Sanofi; Financial Interests, Institutional, Invited Speaker: Sanofi; Financial Interests, Institutional, Invited Speaker: Roche/Genentech; Financial Interests, Institutional, Advisory Board: Roche/Genentech; Financial Interests, Institutional, Advisory Board: Regeneron; Financial Interests, Institutional, Invited Speaker: RTP; Financial Interests, Institutional, Advisory Board: Phosplatin Therapeutics; Financial Interests, Institutional, Advisory Board: PharmaMar; Financial Interests, Institutional, Advisory Board: Pfizer; Financial Interests, Institutional, Invited Speaker: Pfizer; Financial Interests, Institutional, Invited Speaker: PRIME; Financial Interests, Institutional, Invited Speaker: PER; Financial Interests, Institutional, Advisory Board: Novartis; Financial Interests, Institutional, Invited Speaker: Novartis; Financial Interests, Institutional, Advisory Board: Mirati; Financial Interests, Institutional, Advisory Board: Merck Serono; Financial Interests, Institutional, Invited Speaker: Medscape; Financial Interests, Institutional, Invited Speaker: MSD; Financial Interests, Institutional, Advisory Board: MSD; Financial Interests, Institutional, Advisory Board: Janssen; Financial Interests, Institutional, Advisory Board: Incyte; Financial Interests, Institutional, Invited Speaker: Imedex; Financial Interests, Institutional, Advisory Board: Illumina; Financial Interests, Institutional, Invited Speaker: Illumina; Financial Interests, Institutional, Advisory Board: IQVIA; Financial Interests, Institutional, Advisory Board: GlaxoSmithKline; Financial Interests, Institutional, Advisory Board: Gilhead; Financial Interests, Institutional, Advisory Board: Genzyme; Financial Interests, Institutional, Advisory Board: Foundation Medicine; Financial Interests, Institutional, Invited Speaker: Fishawack; Financial Interests, Institutional, Advisory Board: F-Star; Financial Interests, Personal, Other, Associate Editor Annals of Oncology: Elsevier; Financial Interests, Institutional, Advisory Board: Eli Lilly; Financial Interests, Institutional, Invited Speaker: Eli Lilly; Financial Interests, Institutional, Invited Speaker: Ecancer; Financial Interests, Institutional, Advisory Board: Debiopharm; Financial Interests, Institutional, Advisory Board: Daiichi Sankyo; Financial Interests, Institutional, Advisory Board: Boehringer Ingelheim; Financial Interests, Institutional, Invited Speaker: Boehringer Ingelheim; Financial Interests, Institutional, Advisory Board: Blueprint Medicines; Financial Interests, Institutional, Advisory Board: Biocartis; Financial Interests, Institutional, Advisory Board: Bio Invent; Financial Interests, Institutional, Advisory Board: BeiGene; Financial Interests, Institutional, Advisory Board: Bayer; Financial Interests, Institutional, Invited Speaker: BMS; Financial Interests, Institutional, Advisory Board: BMS; Financial Interests, Institutional, Invited Speaker: AstraZeneca; Financial Interests, Institutional, Advisory Board: AstraZeneca; Financial Interests, Institutional, Advisory Board: Arcus; Financial Interests, Institutional, Advisory Board: Amgen; Financial Interests, Institutional, Advisory Board: AbbVie; Financial Interests, Institutional, Advisory Board: iTheos; Financial Interests, Institutional, Advisory Board: Novocure; Financial Interests, Institutional, Invited Speaker: OncologyEducation; Financial Interests, Institutional, Invited Speaker: RMEI; Financial Interests, Institutional, Invited Speaker: Mirati; Financial Interests, Institutional, Invited Speaker, MERMAID-1: AstraZeneca; Financial Interests, Institutional, Invited Speaker, MERMAID-2, POSEIDON, MYSTIC: AstraZeneca; Financial Interests, Institutional, Invited Speaker, Clinical Trial Steering committee CheckMate 743, CheckMate 73L, CheckMate 331 and 451: BMS; Financial Interests, Institutional, Invited Speaker, RELATIVITY 095: BMS; Financial Interests, Institutional, Invited Speaker, BGB-A317-A1217-301/AdvanTIG-301: BeiGene; Financial Interests, Institutional, Invited Speaker, Clinical Trial Chair ZEAL-1: GSK; Financial Interests, Institutional, Invited Speaker, Clinical Trial steering Committee PEARLS, MK-7684A: MSD; Financial Interests, Institutional, Invited Speaker, Clinical Trial Steering Committee SAPPHIRE: Mirati; Financial Interests, Institutional, Invited Speaker, LAGOON: Pharma Mar; Financial Interests, Institutional, Invited Speaker, phase 1/2 trials: Phosplatin Therapeutics; Financial Interests, Institutional, Invited Speaker, Clinical Trial Chair Skyscraper-01; chair ALEX; steering committee BFAST; steering committee BEAT-Meso; steering committee ImPower-030, IMforte: Roche/Genentech; Financial Interests, Institutional, Invited Speaker, Phase 2 Inupadenant with chemo: iTeos; Non-Financial Interests, Personal, Officer, ESMO President 2020-2022: ESMO; Non-Financial Interests, Personal, Officer, Council Member & Scientific Committee Chair: ETOP/IBCSG Partners; Non-Financial Interests, Personal, Officer, Vice-President Lung Group: SAKK; Non-Financial Interests, Personal, Other, Involved in Swiss politics: Swiss Political Activities; Non-Financial Interests, Personal, Officer, President and Council Member: Ballet Béjart Lausanne Foundation; Non-Financial Interests, Personal, Principal Investigator, Involved in academic trials: ETOP / EORTC / SAKK; Non-Financial Interests, Personal, Member: Association of Swiss Physicians FMH (CH); Non-Financial Interests, Personal, Leadership Role, ESMO President: ESMO; Non-Financial Interests, Personal, Member: ASCO; Non-Financial Interests, Personal, Member: AACR; Non-Financial Interests, Personal, Member: IASLC; Non-Financial Interests, Personal, Member, Vice-President Lung Group: SAKK; Non-Financial Interests, Personal, Leadership Role, Vice -President: SAMO; Non-Financial Interests, Personal, Member, Association of Swiss interns and residents: ASMAC/VSAO. R.A. Soo: Financial Interests, Personal, Advisory Board: Amgen; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Advisory Board: Bayer; Financial Interests, Personal, Advisory Board: BMS; Financial Interests, Personal, Invited Speaker: Boehringer Ingelheim; Financial Interests, Personal, Advisory Board: Lily; Financial Interests, Personal, Advisory Board: Merck; Financial Interests, Personal, Advisory Board: Novartis; Financial Interests, Personal, Advisory Board: Pfizer; Financial Interests, Personal, Advisory Board: Roche; Financial Interests, Personal, Other, Conference sponsorship: Taiho; Financial Interests, Personal, Advisory Board: Takeda; Financial Interests, Personal, Advisory Board: Yuhan; Financial Interests, Institutional, Research Grant: AstraZeneca; Financial Interests, Institutional, Research Grant: Boehringer Ingelheim. All other authors have declared no conflicts of interest.