Targeted therapies for NSCLC underused

Nearly a quarter of patients with advanced non-small-cell lung cancer (NSCLC) in Europe, Asia and North America are started on first-line therapy before their EGFR mutation testing results are available, which compromises their access to individualized treatment.

The data, presented at the  European Lung Cancer Conference (ELCC) 2015 held recently in Geneva, Switzerland, came from an international survey that looked at the treatment practices of 562 treating physicians from 10 countries (Canada, France, Germany, Italy, Japan, Korea, Spain, Taiwan, UK and USA). [ELCC 2015, abstract LBA2_PR]

Mutation testing rate was similar in all three regions (82 percent in Asia, 77 in Europe and 76 in NA). “That’s suboptimal, as international guidelines recommend that all advanced NSCLC patients with nonsquamous histology should be tested, so they can receive appropriate treatment according to their mutation status,” remarked Dr. James Spicer of Guy’s hospital, London, UK, who reported the results.

The main reasons for not testing all patients, aside from tumour histology, are insufficient tissue, poor performance status, smoking, and long turnaround time for test results.

“In Asia, more patients are being tested for EGFR mutations and getting the results in a timely manner. Only 10 percent of Asian patients do not have the results before treatment decisions are made, vs 21 percent in North America and 26 percent in Europe,” noted Spicer.

The most important factor in the choice of first-line treatment across all regions was a clinically relevant increase in overall survival, but the survey showed that prescribing practices for EGFR-positive patients vary among regions.

“Physicians in North America and Asia offer significantly more first-line EGFR tyrosine kinase inhibitors [TKIs] than those in Europe [83, 81 and 76 percent, respectively]. Even when available, the use of mutation status to inform treatment decisions is variable, and a significant minority of EGFR-positive patients worldwide receive chemotherapy first, contrary to established guidelines,” he pointed out.

According to Spicer, the reasons why many patients with EGFR mutations receive chemotherapy first need to be understood. “Not being tested or being tested but not given a treatment associated with significant benefits affects patient outcomes,” he concluded.

The discussant, Professor Tony Mok of the Chinese University of Hong Kong, pointed out the survey’s limitations, including the small sample size, selection bias, and differences between types of physicians between continents.

“We don’t know whether the respondents were academic oncologists or private physicians, which may affect their access to EGFR analysis facilities,” he said. “Moreover, we don’t know whether testing or treatment selection had any financial implications for the patient or the physician. For example, were the respondents paid? Are testing and TKI therapy reimbursed?”

Mok also pointed out that a 2011 survey on EGFR mutation testing in Asia showed that overall, only 32 percent of Asian patients were tested, ranging from 18 percent in China to 65 in Japan. “The good news is that the proportion of those tested has been increasing steadily in the past few years,” he said.

“As for the choice of first-line therapy, I don’t think Europe is that different from Asia and North America,” he added.

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