Consideration of EGFR Status in NSCLC Varies Among International Community

April 27, 2015

The International Association for the Study of Lung Cancer (IASLC) guidelines recommend that patients with non-small cell lung cancer (NSCLC) get tested for the epidermal growth factor receptor (EGFR) mutation prior to treatment, but this doesn't always happen, a new study concludes.

The International Association for the Study of Lung Cancer (IASLC) guidelines recommend that patients with non-small cell lung cancer (NSCLC) get tested for the epidermal growth factor receptor (EGFR) mutation prior to treatment, but this doesn't always happen, a new study concludes. This was first reported at the European Lung Cancer Conference (ELCC) in Geneva, Switzerland, April 2015, and was published online in the April 2015 issue of Annals of Oncology. IASLC does not recommend this testing for squamous cell carcinoma (SCC), only NSCLC.

James Spicer, MRCP, PhD, a medical oncologist at King’s College London at Guy’s Hospital, London, and colleagues took a look at hospitals globally to learn how and when they were testing for the EGFR gene in patients with stage IIIb/IV lung cancer.

To find out what was happening in hospitals worldwide, the investigators conducted an online survey of 562 oncologists in 10 countries (Canada, France, Germany, Italy, Japan, South Korea, Spain, Taiwan, United Kingdom, and the United States) between December 2014 and January 2015. The researchers in London discovered that the EGFR test was being requested approximately 81% of the time, but first-line treatment, for some patients, was underway before the results came in. This occurred for several reasons; in some cases, the wait time for results was too long for the patients with advanced cancer who needed immediate treatment. Other times, tissue was not available.

Mutation test results were available before administration of first-line therapy in 77% of patients who were tested, but the differences between countries are notable; 51% in France to 89% in Japan; P < .001. Eighty percent of patients with mutations were treated with a tyrosine-kinase inhibitor (TKI); 60% in Canada to 91% in Taiwan. One sharp contrast among oncologists is the 23% who do not test for or consider EGFR mutation subtypes in making treatment decisions. This is important because matching mutations to specific TKI treatment can improve overall survival (OS).

In comparison, nearly half (49%) of the survey participants reported that their decision, including specific TKI selection, is affected by the mutation detected. Two-thirds of oncologists reported that a clinically relevant increase in OS is very important when choosing a first-line therapy for NSCLC patients with the mutation.

This study illustrates the differences among countries and highlights the need for more cross-communication among oncologists.