Abstract 1402P
Background
EGFRm testing is standard of care in patients with metastatic NSCLC. However, real-world uptake of testing and biomarker-informed treatment remains unclear. This retrospective, real-world, US electronic health records (EHR) database study describes EGFRm testing patterns, turnaround time (TAT) and associated treatment choice in patients with aNSCLC.
Methods
Adults with aNSCLC (Stage IIIB–IV or recurrent metastatic) diagnosed (index date) 1 Jan 2016 – 31 Aug 2017, receiving post-index first-line (1L) treatment from the Flatiron Health network (>245 cancer clinics) were included and followed until 31 Aug 2019. Demographics, disease characteristics, TAT (time from date of diagnosis of aNSCLC to date of EGFRm test result) and treatment choice were extracted from the database.
Results
Of 7171 eligible patients (median age, 69 years [interquartile range, IQR 61, 76]; 47% were female; staging at initial diagnosis: not reported 2%, I–IIIA 18%, IIIB/C 13%, IV 67%), 71% (5088/7171) received at least one EGFRm test, with valid test results (defined as a positive or negative result) obtained from 96% of those patients (4861/5088). The majority of these patients also had ALK (4905/5088 [96%]) and ROS1 fusions (3983/5088 [78%]) testing; PD-L1 was tested in 78% of patients (3985/5088). Approximately half of patients had KRAS (2759/5088 [54%]) and BRAF (2652/5088 [52%]) testing. In patients with valid tests, 72% (3521/4861) had results prior to initiating 1L treatment. In patients positive for EGFRm (651; 13%), the majority (587/651 [90%]) received an EGFR tyrosine kinase inhibitor (TKI); however, longer TAT was associated with an extended time to initiation of treatment (Table). Table: 1402P
| EGFRm TAT in patients who received an EGFR-TKI, weeks (N=587) | Median time from diagnosis of aNSCLC to initiation of EGFR-TKI treatment, weeks (IQR) |
| 0–1 (n=52) | 3.5 (2.0, 6.6) |
| 1–2 (n=170) | 3.6 (2.3, 6.1) |
| 2–3 (n=138) | 4.7 (3.6, 7.8) |
| 3–4 (n=85) | 5.8 (4.8, 8.4) |
| 4–5 (n=57) | 6.5 (5.1, 8.8) |
| >5 (n=149) | 11.0 (7.1, 27.5) |
Conclusions
In this large real-world US data set, 71% of patients with aNSCLC were tested for EGFRm, 13% of whom tested positive. Delayed initiation of EGFR-TKI treatment was seen in those with longer TAT. Impact on patient outcomes is being explored.
Clinical trial identification
Editorial acknowledgement
We thank Donna Tillotson, PhD, from iMed Comms, an Ashfield Company, part of UDG Healthcare plc, who provided medical writing support funded by AstraZeneca.
Legal entity responsible for the study
The authors.
Funding
AstraZeneca.
Disclosure
J. Subramanian: Advisory/Consultancy, Speaker Bureau/Expert testimony: AstraZeneca; Advisory/Consultancy, Speaker Bureau/Expert testimony: Boehringer Ingelheim; Advisory/Consultancy: Cardinal Health; Advisory/Consultancy: Lilly; Advisory/Consultancy: Novartis; Advisory/Consultancy: Pfizer; Leadership role: Paradigm Diagnostics; Research grant/Funding (institution): Biocept. J. Gregg: Speaker Bureau/Expert testimony, Research grant/Funding (institution): AstraZeneca; Advisory/Consultancy: BMS. H. Wang: Full/Part-time employment: GSK; Spouse/Financial dependant, Spouse is a Pfizer employee: Pfizer. P. Sun: Full/Part-time employment: AstraZeneca. B. Yu: Shareholder/Stockholder/Stock options, Full/Part-time employment: AstraZeneca. R. Shenolikar: Shareholder/Stockholder/Stock options, Full/Part-time employment: AstraZeneca. M. Chau: Shareholder/Stockholder/Stock options: Roche; Shareholder/Stockholder/Stock options, Full/Part-time employment: AstraZeneca. A. Taylor: Shareholder/Stockholder/Stock options, Full/Part-time employment: AstraZeneca. All other authors have declared no conflicts of interest.