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 EGFR mutations, a significant number of those tested were not receiving personalized treatments for their cancer type and mutation subtype. (1) The survey results from 562 oncologists from 10 countries (Canada, France, Germany, Italy, Japan, Korea, Spain, Taiwan, UK and USA) were presented as a late-breaking abstract in the ESMO-IASLC Best Abstracts session at the 2015 European Lung Cancer Conference in Geneva, Switzerland. The survey was sponsored by Boehringer Ingelheim.
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 (range: 12% in Asia to 30% in Europe).(1) The main reasons for not testing all patients, aside from tumor histology, were insufficient tissue/uncertainty of sufficient tissue, poor patient fitness, and 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.(1) Again, there was significant variation between regions (range: 28% in Asia to 60% in Europe).(1)
International guidelines(2) recommend that EGFR mutation testing should be performed at diagnosis of advanced NSCLC 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.(2) 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.(3)
"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 emphasising 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.
NSCLC is the most common form of lung cancer.(4) Specific changes in the tumour, known as EGFR mutations, are found in 10-15% of white and 40% of East Asian patients with NSCLC.(5) There are different types of EGFR mutations, the most common being exon 19 deletions (Del19) and the exon 21 (L858R) substitution.(6)
Dr Matthew Peters, chair of the Global Lung Cancer Coalition said, "This research clearly shows there are patterns of care in the evaluation and initial treatment of lung cancer which do not always include EGFR testing. Patients should expect that lung cancer clinicians and pathology providers are working together to rapidly establish the facts around a lung cancer diagnosis, in accordance with international guidelines, so that appropriate treatment can be applied with the goal of optimal outcomes."
Professor Gerd Stehle, Vice President Medicine Therapeutic Area Oncology, Boehringer Ingelheim commented: "Boehringer Ingelheim's commitment to lung cancer research goes beyond clinical trials. This global survey is part of our continuous efforts to better understand what really happens in clinical practice so we can use these insights to better support the needs of patients with lung cancer and those who care for them."
About the survey
In a quest to better understand advanced NSCLC diagnosis, mutation testing and treatment practices, a global online survey of 562 physicians was conducted in 10 countries (Canada, France, Germany, Italy, Japan, South Korea, Spain, Taiwan, UK and US). The survey, conducted between December 2014 and January 2015, assessed the prevalence of EGFR mutation testing globally, attitudes and barriers to testing, and how test results affect choice of therapy.
About Boehringer Ingelheim
The Boehringer Ingelheim group is one of the world's 20 leading pharmaceutical companies. Headquartered in Ingelheim, Germany, Boehringer Ingelheim operates globally with 142 affiliates and a total of more than 47,400 employees. The focus of the family-owned company, founded in 1885, is researching, developing, manufacturing and marketing new medications of high therapeutic value for human and veterinary medicine.
Taking social responsibility is an important element of the corporate culture at Boehringer Ingelheim. This includes worldwide involvement in social projects, such as the initiative "Making more Health" and caring for the employees. Respect, equal opportunities and reconciling career and family form the foundation of the mutual cooperation. In everything it does, the company focuses on environmental protection and sustainability.
In 2013, Boehringer Ingelheim achieved net sales of about 14.1 billion euros. R&D expenditure corresponds to 19.5% of its net sales.
1. Spicer J, Tischer B, Peters M. EGFR Mutation Testing and Oncologist Treatment Choice in Advanced NSCLC: Global Trends and Differences. Presented at ELCC 2015, abstract number LBA2_PR.
2. Lindeman NI, Cagle PT, Beasley MB, et al. Molecular Testing Guideline for Selection of Lung Cancer Patients for EGFR and ALK Tyrosine Kinase Inhibitors: Guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology. J Thorac Oncol 2013 ;8:823-59.
3. Yang J, Wu Y-L, Schuler M, et al. Afatinib versus cisplatin chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): analysis of overall survival data from two randomised, phase 3 trials. Lancet Oncol 2015. http://www.thelancet.com/journals/lancet/article/PIIS1470-2045(14)71173-8/abstract.
4. Cancer Research UK. Types of Lung Cancer. http://www.cancerresearchuk.org/about-cancer/type/lung-cancer/about/types-of-lung-cancer Accessed February 2015.
5. Quest Diagnostics – Lung Cancer Mutation Panel; http://www.questdiagnostics.com/testcenter/testguide.action?dc=TS_LungCancerMutation_Panel Accessed February 2015.
6. Reguart N & Remon J. Common EGFR-mutated subgroups (Del19/L858R) in advanced non-small-cell lung cancer: chasing better outcomes with tyrosine-kinase inhibitors. Future Oncol 2015 Jan 28:1-13. [Epub ahead of print].