1157P - Diagnostic therapeutic pathway (DTP) of early stage non-small cell lung cancer (eNSCLC): A real-world focus on EGFR status detection in resected patients (pts)

Background

The phase III randomized ADAURA trial showed a prolongation of median relapse free survival (mRFS) of EGFR-mutant (mut) eNSCLC pts receiving osimertinib as adjuvant (adj) treatment (trt). Currently, REFLEX EGFR test on biopsy or surgical specimens of eNSCLC is not widely performed across Italian Centres, though may impact on therapeutic chances and outcome.

Methods

This is an observational study enrolling chemo-naïve stage I-III lung adenocarcinomas referred to our Unit between January 2017 and October 2018. The DTP was measured through indicators defined by the DTP regional document; a cost evaluation for cancer care in this setting was depicted through administrative data flows (ADF) from anonymized pts.

Results

Data from 144 resected pts are reported: 84(58.3%) were males, 25(17.4%) never smokers. Pre-surgery diagnostic biopsy (bio) was performed in 66(45.8%) and EGFR REFLEX test in 39 (88.6%) pts out of 44 done at our center. Most pts underwent lobectomy (79%) plus lymphadenectomy. Pathological stage was I in 59.0%, II in 18.9%, IIIA in 15.3% and IIIB in 6.9% of pts. On surgical specimens, REFLEX test was performed in 118(81.9%) pts; detection methods were RT-PCR (15.3%), Sanger sequencing (37.3%) and mass spectrometry (47.5%). Median time to EGFR report from pathology unit registration was 20 days (range 11-95) and 21 days (9-67), for bio samples and specimens respectively. 28 (19.4%) pts were EGFR-mut. Among pts with available follow-up data, 9.7% received adj trt. At data cut-off (9^th April 2021), mRFS has not been reached. Among relapsed pts (N=33, 22.9%), 5(15.2%) were EGFR-mut; a trend to longer RFS was observed for EGFR-mut pts (p=0.19). A cost-consequence analysis from ADF showed a medium cost of € 34.340,4 (28.423,2-40.257,5) for the whole management of eNSCLC cases incident in 2017 and undergoing radical surgery, and 2 year survival of 79.6%. Costs of RT-PCR and Sanger sequencing was € 544,55 and 814,70 per pts according to reimbursement rates established by the Veneto Regional Authority.

Conclusions

EGFR REFLEX test in eNSCLC pts is feasible in terms of timing and costs and allows the selection of pts that could benefit from the upcoming osimertinib adj trt.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Istituto Oncologico Veneto IRCCS.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.