Abstract 1403P
Background
Since 2013, the national Norwegian guidelines recommend that all non-squamous non-small cell lung carcinomas (NSCLC) are tested for epidermal growth-factor receptor mutations (EGFRm+). For EGFRm+ advanced NSCLC patients, 1st line palliative treatment with tyrosine kinase inhibitors (TKI) is recommended. This is the first nation-wide study describing real-world EGFR testing and subsequent TKI-treatment patterns in Norway.
Methods
All patients with locally advanced (LA) or metastatic non-squamous NSCLC during 2010-2017 were included. Cancer Registry data were linked to Norwegian national health registries data on medical history and TKI use. The proportion of EGFR-tested patients and subsequently treated with TKI was estimated using time to event methods.
Results
Of 10717 patients (mean age 71 years, female 47%), 3782 (35%) were diagnosed with LA NCSLC and 6935 (65%) with metastatic NSCLC. Among LA, 58% were EGFR tested, of which 7% were EGFRm+. Younger age (<60 vs. ≥80) was associated with being EGFR tested (HR: 1.5, 95% CI1.3-1.8), and testing over time (≤2011 vs. ≥2016) increased with 80% (HR: 1.8, 95% CI1.6-2.0). For metastatic NSCLC, 53% were EGFR tested and 9% were EGFRm+. Similarly, younger patients were more likely to be tested (HR: 1.6, 95% CI1.4-1.8), and testing doubled over time (HR: 2.0, 95% CI1.8-2.2). For LA EGFRm+ and metastatic EGFRm+, 58% and 85% initiated TKI treatment, respectively. Median (IQR) time to treatment initiation was 142 (31-400) and 30 (20-63) days, respectively. Probability of treatment was not associated with age or study period.
Conclusions
Increases in EGFR testing were observed over time, which may reflect improvement in routine diagnostics according to guidelines. Initiation of TKI treatment in metastatic EGFRm+ NSCLC was substantial and independent of patient characteristics. Time to TKI treatment initiation in LA EGFRm+ NSCLC showed a greater variation than for the patients with metastatic disease, which may reflect different treatment options in accordance with the guidelines.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
AstraZeneca.
Funding
AstraZeneca.
Disclosure
Å. Helland: Research grant/Funding (institution): Roche; Research grant/Funding (institution): AstraZeneca; Research grant/Funding (institution): BMS; Research grant/Funding (institution): Ultimovacs. K.K. Andersen, T. Hallerbäck: Full/Part-time employment: AstraZeneca. E. Enerly: Research grant/Funding (institution): AstraZeneca. All other authors have declared no conflicts of interest.