A multicenter survey of first-line treatment patterns and gene aberration test status of patients with unresectable Stage IIIB/IV nonsquamous non-small cell lung cancer in China (CTONG 1506)

Abstract

BackgroundIn recent years, systemic chemotherapy and molecular targeted therapy have become standard first-line treatments for locally advanced or metastatic nonsquamous non-small cell lung cancer (NSCLC). The objective of this survey was to investigate first-line anticancer treatment patterns and gene aberration test status of patients with advanced nonsquamous NSCLC in China.MethodsPatients included in this study had unresectable Stage IIIB/IV nonsquamous NSCLC and were admitted during August 2015 to March 2016 into one of 12 tertiary hospitals throughout China for first-line anticancer treatment. Patient data (demographics, NSCLC histologic type, Eastern Cooperative Oncology Group [ECOG] Performance Status [PS], gene aberration test and results [if performed], and first-line anticancer treatment regimen) were extracted from medical charts and entered into Medical Record Abstraction Forms (MERAFs), which were collated for analysis.ResultsOverall, 1041 MERAFs were collected and data from 932 MERAFs were included for analysis. Patients with unresectable Stage IIIB/IV nonsquamous NSCLC had a median age of 59 years, 56.4% were male, 58.2% were never smokers, 95.0% had adenocarcinoma, and 92.9% had an ECOG PS ≤1. A total of 665 (71.4%) patients had gene aberration tests; 46.5% (309/665) had epidermal growth factor receptor (EGFR) gene mutations, 11.5% (48/416) had anaplastic lymphoma kinase (ALK) gene fusions, and 0.8% (1/128) had a c-ros oncogene 1 gene fusion. The most common first-line treatment regimen for unresectable Stage IIIB/IV nonsquamous NSCLC was chemotherapy (72.5%, 676/932), followed by tyrosine kinase inhibitors (TKIs; 26.1%, 243/932), and TKIs plus chemotherapy (1.4%, 13/932). Most chemotherapy regimens were platinum-doublet regimens (93.5%, 631/676) and pemetrexed was the most common nonplatinum chemotherapy-backbone agent (70.2%, 443/631) in platinum-doublet regimens. Most EGFR mutation-positive patients (66.3%, 205/309) were treated with EGFR-TKIs.ConclusionsFindings from our survey of 12 tertiary hospitals throughout China showed an increased rate of gene aberration testing, compared with those rates reported in previous surveys, for patients with advanced nonsquamous NSCLC. In addition, pemetrexed/platinum-doublet chemotherapy was the predominant first-line chemotherapy regimen for this population. Most patients were treated based on their gene aberration test status and results.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3451-x) contains supplementary material, which is available to authorized users.

Development and validation of a model to predict tyrosine kinase inhibitor‐sensitive EGFR mutations of non‐small cell lung cancer based on multi‐institutional data

“…According to data from the CTONG 1506 multicenter survey, tobacco consumption is also negatively associated with EGFR mutations. EGFR mutation rates in never, former, and current smokers are reported as 54.4%, 36.0%, and 30.6% ( P < 0.001), respectively . Our study further confirmed the association between these factors and the presence of sensitive del19 and L858R mutations.…”

“…EGFR mutation rates in never, former, and current smokers are reported as 54.4%, 36.0%, and 30.6% (P < 0.001), respectively. 23 Our study further confirmed the association between these factors and the presence of sensitive del19 and L858R mutations. Late N and M stage, and brain metastasis were also independent predictive factors of TKI-sensitive mutations, consistent with the adverse influence of EGFR on patient prognosis.…”

“…Younger patients (aged < 60-65 years) seemed more likely to have EGFR mutations compared to older patients. 22,23 However, age was not an independent predictor of TKI-sensitive mutations in our study. CEA and Cyfra 21-1 are well-known serum tumor markers of NSCLC.…”

“…and the CTONG 1506 study both reported that age at diagnosis was related to EGFR mutation status. Younger patients (aged < 60–65 years) seemed more likely to have EGFR mutations compared to older patients . However, age was not an independent predictor of TKI‐sensitive mutations in our study.…”

Multicenter study of diagnostic procedures, genetic aberration analysis, and first‐line treatment of lung cancer in Jiangsu Province, China

“…However, recent a multicenter survey of stage IIIB/IV NSCLC in China showed that chemotherapy was still the most common first‐line regimen (72.5%), but pemetrexed plus platinum was predominant (70.2%); the detection rate of EGFR gene mutation was 71.4% and the positive rate was 46.5%. Furthermore, 66.3% of patients with positive EGFR gene mutation were treated with EGFR‐tyrosine kinase inhibitors . This shows the treatment model in China has changed in recent years.…”