Results from a new global survey of lung cancer oncologists have shown that, despite 81% of newly diagnosed advanced non-small cell lung cancer (NSCLC) patients being tested for Epidermal Growth Factor Receptor mutations (EGFR), a significant number of those tested were not receiving personalized treatments for their cancer type and mutation subtype. The survey, with results from 562 oncologists from 10 different countries, was presented at the 2015 European Lung Cancer Conference in Geneva, Switzerland. The survey was sponsored by Boehringer Ingelheim.
NSCLC is the most common form of lung cancer. Specific changes in the tumour, known as EGFR mutations, are found in 10-15% of white and 40% of East Asian patients with NSCLC. There are different types of EGFR mutations, the most common being exon 19 deletions (Del19) and the exon 21 (L858R) substitution.
The survey highlighted that almost one in four advanced NSCLC patients were started on first-line treatment before their mutation test results were available, with significant differences between regions (from 12% in Asia to 30% in Europe). The main reasons for not testing all patients, aside from tumour histology, were:
• insufficient tissue/uncertainty of sufficient tissue
• poor patient fitness
• test results taking too long to come back
In addition, half of all oncologists (51%) stated that their treatment decision was not affected by EGFR mutation subtype. Again, there were significant variations between regions (from 28% in Asia to 60% in Europe).
International guidelines recommend that EGFR mutation testing should be performed as soon as advanced NSCLC is diagnosed and results should guide treatment decisions to ensure all patients receive targeted therapy according to their specific cancer type. This is important because patients who have advanced EGFR-mutated lung cancer can benefit from targeted treatments which can improve quality of life and progression-free survival compared to standard chemotherapy. Furthermore, recent data have shown that a specific targeted therapy extended overall survival of patients with the most common type of mutation (Del19) when compared to chemotherapy.
“On average, EGFR mutation testing rates are relatively high across the globe; however, we should be aiming for every suitable NSCLC patient to be tested, and every patient receiving an appropriate treatment for their type of lung cancer. These new survey results highlight that there is still work to be done in emphasizing the importance of obtaining EGFR test results prior to the initiation of treatment, and using this vital information to select optimum therapy,” commented Dr James Spicer, of King’s College London, at Guy’s Hospital, London, UK.
The survey conducted in 10 countries (Canada, France, Germany, Italy, Japan, Korea, Spain, Taiwan, UK and USA) was sponsored by German pharma Boehringer Ingelheim, who developed Giotrif, an EGFR inhibitor to treat metastatic NSCLC.