Usage of epidermal growth factor mutation testing and impact on treatment patterns in non-small cell lung cancer: An international observational study.

Epidermal growth factor receptor (EGFR) mutations (EGFRm) are common oncogene drivers in non-small cell lung cancer (NSCLC). This real-world study explored treatment patterns and time to receive EGFRm test results in patients with advanced EGFRm NSCLC. A cross-sectional medical chart review was completed May-August 2020 in Australia, Canada, Germany, Italy, South Korea, Taiwan, UK, and USA. Eligible patients had advanced NSCLC and a positive EGFRm test result January-December 2017. Data were abstracted from NSCLC diagnosis to end of follow-up (31 March 2020) or patient's death whichever occurred earlier. The index date was the date of EGFRm confirmation. 223 physicians provided data for 1,793 patients. Patients' mean age was 64.7 years, 54 % were male, 30.7 % had no history of smoking. Overall, 78 % of EGFRm test results were received ≤ 2 weeks after request (range of median 7-14 days across countries). Median time from advanced NSCLC diagnosis to EGFRm test result was 18 days (median range 10-22 days across countries). Over a third (37 %) of patients received a systemic treatment prior to EGFRm result; chemotherapy (25 %) and EGFR-TKI (15 %) were most commonly prescribed; post-EGFR test-result was EGFR-TKI (68 %); 80 % of patients initiated EGFR-TKI at any time point post-NSCLC diagnosis. Of those receiving a first-line EGFR-TKI post-EGFRm testing, 84 % received a TKI alone, 12 % in combination with chemotherapy, and 3 % with other treatments. Median time from first-line EGFR-TKI initiation post-EGFRm testing to first subsequent treatment was 19.8 months. Over one-fifth of patients wait >14 days for their EGFRm test results, affecting their likelihood of receiving first-line EGFR-TKI with 20 % of patients never receiving EGFR TKI treatment. There was significant inter-country variability in the proportion of patients receiving EGFR TKIs. Our study highlights the need to improve EGFRm testing turnaround times and treatment initiation across countries.

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Declaration of Competing Interest Janakiraman Subramanian: Advisory board member for AstraZeneca, Boehringer Ingelheim, Daichi-Sankyo, Eli Lilly, G1 therapeutics, Jazz Pharma, Janssen, Novartis, Pfizer; Takeda; Speaker honorarium from AstraZeneca, G1 therapeutics, Janssen, Jazz Pharma & Boehringer Ingelheim. Natasha Leighl: Honoraria received for CME lectures from Amgen, BMS, GlaxoSmithKline, MSD, Novartis, Puma Biotechnology, Sanofi Genzyme and Takeda; Institutional research funding received from Amgen, Array, AstraZeneca, Bayer, BMS, Eli Lilly, EMD Serono, Guardant Health, Inivata, MSD, Novartis, Pfizer, Roche and Takeda. Yoon-La Choi: No disclosures or potential conflicts of interest. Teh-Ying Chou: No disclosures or potential conflicts of interest. Jeffrey Gregg is an employee of Harbinger Oncology, Cambridge, MA, USA. Rina Hui: Advisory board member for AstraZeneca, BMS, Eisai, Eli Lilly, Merck, MSD, Novartis, OncoSec, Pfizer, Roche, Seagen; Speaker honorarium from AstraZeneca, Eli Lilly, MSD, Novartis. Antonio Marchetti: No disclosures or potential conflicts of interest. Neal Navani is supported by an MRC Clinical Academic Research Partnership (MR/T02481X/1), and has received honoraria or non-financial support for advisory boards or speaker bureau from Amgen, AstraZeneca, Bristol-Meyers Squibb, Guardant, Janssen, Lilly & Co, Merck Sharp and Dohme, Olympus, Oncimmune, OncLive, PeerVoice, Pfizer and Takeda, outside of the submitted work. Maiyan Chau and Aliki Taylor are employees of AstraZeneca, Cambridge, UK; Maiyan Chau owns stock and stock options in AstraZeneca. Doreen A Kahangire is a Consultant of AZ Cambridge, UK and does not own or hold stock options. Tom Bailey, Mark Silvey, Rebecca Makin, and Liane Gillespie‑Akar are employees of Adelphi Real World, Bollington, Cheshire, UK.