Approximately 1 in 4 Patients with Lung Cancer Are Not Tested for EGFR Mutations

Alice Goodman

May 2015, Vol 6, No 4 - Lung Cancer

Geneva, Switzerland—A study with ­real-world data showed that almost 1 in 4 (24%) patients with advanced lung cancer are not receiving appropriate testing for EGFR mutations, even though guidelines recommend this genetic test to guide the selection of the most appropriate therapy.

This important finding was reported at the 2015 European Lung Cancer Conference by James Spicer, MBBS, PhD, Reader in Experimental Oncology, King’s College London, United Kingdom.

Dr Spicer said that in Europe and in North America, almost 25% of patients are not tested for EGFR mutations, and up to 20% of patients are tested, but the results are not available at the time the treatment decision is made.

Failure to test patients for this mutation has the potential to lead to suboptimal outcomes, he continued, because targeted therapy with an EGFR inhibitor is more effective for cancers that carry the EGFR mutation.

Current Guidelines, EGFR Inhibitors Require Testing

“The arrival of a new group of EGFR inhibitors for the treatment of lung cancer driven by mutations in the EGFR gene has brought with it a new requirement for diagnostic laboratories to implement genetic testing. For many institutions, this has represented a significant departure from traditional pathology, which has previously focused only on microscopic examination of tumor tissue,” Dr Spicer commented in the news release.

The ability to test for molecular alterations has taken time to percolate down to clinical practice. Dr Spicer and colleagues had anecdotal evidence to suggest that in the real world, mutational testing was falling through the cracks for some patients.

To get a better idea of the uptake of EGFR testing, he and his colleagues conducted an online survey of 562 oncologists in 10 countries between December 2014 and January 2015. The 10 countries included Canada, France, Germany, Italy, Japan, South Korea, Spain, Taiwan, the United Kingdom, and the United States.

The investigators found that in Europe and North America, 24% of patients with advanced lung cancer were not tested for EGFR mutations. Moreover, even in some situations where patients were tested, the test results were not considered when deciding between first-line therapy with an EGFR inhibitor or chemotherapy.

Reasons for Lack of Testing Adherence

The reasons cited by survey respondents for not ordering testing and not following guidelines related to test results included the lack of sufficient tissue, a long turnaround time for testing, and patients’ poor performance status.

Silvia Novello, MD, PhD, Associate Professor, Department of Oncology, University of Turin, Italy, commented on the study, noting, “The first 2 reasons are partially related to an incomplete integration of multidisciplinary oncology teams, while the third one can be attributed to an imperfect knowledge of data regarding the use of EGFR inhibitors.”

EGFR inhibitors are associated with a survival benefit in advanced lung cancer, and these results suggest that many patients are denied access to the best treatment because of a lack of EGFR testing or failure to incorporate results in treatment selection.

Dr Novello stated that it was interesting that the investigators were able to show that EGFR mutation testing was requested before first-line therapy in 81% of patients with stage IIIb/IV non–small-cell lung cancer cases. She said it was also interesting that results were demonstrated to be available before administration of treatment in 77% of cases.