EGFR Mutation Testing of non-squamous NSCLC: Impact and Uptake during Implementation of Testing Guidelines in a Population-Based Registry Cohort from Northern New Zealand

McKeage, Mark J.; Elwood, Mark; Tin, Sandar Tin; Khwaounjoo, Prashannata; Aye, Phyu Sin; Li, Angie; Sheath, Karen; Shepherd, Phillip; Laking, George; Kingston, Nicola; Love, Donald R.

doi:10.1007/s11523-017-0515-4

Cited by 15 publications

(27 citation statements)

References 52 publications

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“…In 2010, the EGFR testing rate for NSCLC patients was 16.8% in the United States, compared to 63.5% in Korea . In 2012, a Swedish study reported that 49% of advanced NSCLC patients were tested for the EGFR gene, while a 2014 study conducted in New Zealand revealed the EGFR testing rate to be 67% . As EGFR mutations are more common in Asian compared to Western patients, EGFR molecular testing in Chinese patients is important.…”

Section: Introductionmentioning

confidence: 99%

Real‐world EGFR testing in patients with stage IIIB/IV non‐small‐cell lung cancer in North China: A multicenter, non‐interventional study

Cheng¹,

Wang

Zhao

et al. 2018

Thoracic Cancer

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BackgroundBefore tyrosine kinase inhibitor (TKI) therapy can be administered in patients with advanced non‐small cell lung cancer (NSCLC), EGFR mutation testing is required. However, few studies have evaluated the extent of EGFR testing in real‐world practice in China.MethodsA multicenter, observational study of EGFR testing in NSCLC patients in North China was conducted. Treatment‐naïve patients or those with postoperative recurrent stage IIIB/IV NSCLC were enrolled. The primary objective was EGFR testing rate. Secondary objectives included EGFR mutation status, EGFR testing methods and specimens, factors associated with EGFR testing, and overall survival with or without EGFR testing.ResultsOverall, 2809 patients with stage IIIB/IV NSCLC were enrolled; 90.78% had adenocarcinoma. The EGFR screening rate was 42.54%. EGFR testing rates were higher in tumor samples obtained by lymph node puncture, and in patients with urban medical insurance, adenocarcinoma, non‐smokers, or those located in developed cities (all P < 0.001). The EGFR mutation rate was 46.44%. The most commonly used specimens for EGFR testing were biopsy tumor samples (67.53%). PCR‐based methods (72.05%), Sanger sequencing (5.36%), and Luminex liquid chip (5.10%) were the most frequently used testing platforms. Similar positive EGFR mutation rates were achieved with different platforms. TKI therapy was the first‐line treatment administered to most EGFR‐positive patients (56.22%), and chemotherapy in EGFR‐negative patients (84.88%). Overall survival was higher in EGFR‐tested than in untested patients (27.50 vs. 19.73 months; P = 0.007).ConclusionReal‐world EGFR testing rates for NSCLC in North China were relatively low because of clinical and social factors, including medical insurance coverage.

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Section: Introductionmentioning

confidence: 99%

Real‐world EGFR testing in patients with stage IIIB/IV non‐small‐cell lung cancer in North China: A multicenter, non‐interventional study

Cheng¹,

Wang

Zhao

et al. 2018

Thoracic Cancer

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“…Although the proportion of patients with ALK‐positive NSCLC is relatively modest, there is still a substantial number of ALK‐positive patients likely to present each year who will benefit from treatment with ALK TKI. Each year in New Zealand, approximately 1200 patients are diagnosed with non‐squamous NSCLC, so it is likely that about 50 to 100 of these individuals will have ALK‐positive disease.…”

Section: Discussionmentioning

confidence: 99%

“…The study was approved by the Northern Health and Disability Ethics committee (No: 13/NTB/165/AM02) and registered (ACTRN12615000998549). More details about the study design and setting are described elsewhere …”

Section: Methodsmentioning

confidence: 99%

“…Over the past 10 to 15 years, an improved understanding of the molecular pathogenesis of malignancy has led to the development of new molecularly‐targeted anticancer agents. Advances against non‐squamous non‐small‐cell lung cancer (NSCLC), which accounts for about 62% of lung cancer cases in New Zealand, include the identification of driver mutations in tyrosine kinase genes. These genes include anaplastic lymphoma kinase ( ALK ), epidermal growth factor receptor ( EGFR ), RET , ROS1 , HER2 and others .…”

Section: Introductionmentioning

confidence: 99%

“…As a result, international and national clinical practice guidelines recommend genetic testing of tumour samples from all patients diagnosed with non‐squamous NSCLC to select a specific tyrosine kinase inhibitor (TKI) drug for each patient that is matched to their lung cancer driver gene . For example, in recent years in New Zealand, national guidelines for EGFR gene mutation testing were developed and state‐subsidised EGFR TKI drugs are available . However, to date, no such guidelines exist in this country for ALK testing.…”

Section: Introductionmentioning

confidence: 99%

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Screening for anaplastic lymphoma kinase (ALK) gene rearrangements in non‐small‐cell lung cancer in New Zealand

McKeage

Tin

Khwaounjoo

et al. 2020

Internal Medicine Journal

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Background Lung cancer is a major cause of death in New Zealand. In recent years, targeted therapies have improved outcomes. Aim To determine the uptake of anaplastic lymphoma kinase (ALK) testing, and the prevalence, demographic profile and outcomes of ALK‐positive non‐small‐cell lung cancer (NSCLC), in New Zealand, where no national ALK‐testing guidelines or subsidised ALK tyrosine kinase inhibitor (TKI) therapies are available. Methods A population‐based observational study reviewed databases to identify patients presenting with non‐squamous NSCLC over 6.5 years in northern New Zealand. We report the proportion tested for ALK gene rearrangements and the results. NSCLC samples tested by fluorescence in situ hybridisation were retested by next generation sequencing and ALK immunohistochemistry. A survival analysis compared ALK‐positive patients treated or not treated with ALK TKI therapy. Results From a total of 3130 patients diagnosed with non‐squamous NSCLC, 407 (13%) were tested for ALK gene rearrangements, and patient selection was variable and inequitable. Among those tested, 34 (8.4%) had ALK‐positive NSCLC. ALK‐positive disease was more prevalent in younger versus older patients, non‐smokers versus smokers and in Māori, Pacific or Asian ethnic groups than in New Zealand Europeans. Fluorescence in situ hybridisation, ALK immunohistochemistry and next generation sequencing showed broad concordance for detecting ALK–positive disease under local testing conditions. Among patients with ALK‐positive metastatic NSCLC, those treated with ALK TKI survived markedly longer than those not treated with ALK TKI (median overall survival 5.12 vs 0.55 years). Conclusion Lung cancer outcomes in New Zealand may be improved by providing national guidelines and funding policy for ALK testing and access to subsidised ALK TKI therapy.

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Utilisation and Determinants of Epidermal Growth Factor Receptor Mutation Testing in Patients with Non-small Cell Lung Cancer in Routine Clinical Practice: A Global Systematic Review

et al. 2020

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EGFR Mutation Testing of non-squamous NSCLC: Impact and Uptake during Implementation of Testing Guidelines in a Population-Based Registry Cohort from Northern New Zealand

Abstract: In this real world setting, high uptake of EGFR testing was achieved and associated with major changes in EGFR-TKI prescribing and improved health outcomes. Modifiable factors determined testing uptake. Study registration ACTRN12615000998549.

Cited by 15 publications

References 52 publications

Real‐world EGFR testing in patients with stage IIIB/IV non‐small‐cell lung cancer in North China: A multicenter, non‐interventional study

Real‐world EGFR testing in patients with stage IIIB/IV non‐small‐cell lung cancer in North China: A multicenter, non‐interventional study

Screening for anaplastic lymphoma kinase (ALK) gene rearrangements in non‐small‐cell lung cancer in New Zealand

Utilisation and Determinants of Epidermal Growth Factor Receptor Mutation Testing in Patients with Non-small Cell Lung Cancer in Routine Clinical Practice: A Global Systematic Review

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