Progress Seen With EGFR Testing, But Adoption Still Lagging

Incomplete implementation of EGFR testing guidelines remains a problem in the realm of non-small cell lung cancer (NSCLC), according to a study published in the Journal of Global Oncology. The authors say that non-testing means a large proportion of patients cannot receive life-extending targeted therapies.

While international guidelines recommend testing for EGFR mutation at diagnosis of advanced NSCLC to guide treatment, the extent of adoption of testing has not been fully understood. Thus, an international group of researchers conducted two surveys, 18 months apart, to identify changes in EGFR mutation testing and treatment practices.

The first online survey questioned 562 physicians (oncologists, pulmonologists, and thoracic/respiratory surgeons) from Canada, France, Germany, Italy, Japan, South Korea, Spain, Taiwan, the United Kingdom, and the United States (December 2014 to January 2015). The second round surveyed 707 physicians in the same countries, plus China, between July and August 2016. All respondents verified they had a role in treatment decisions for patients with NSCLC (an average of 70 patients per physician).

The researchers found that globally, physicians requested EGFR mutation testing for 80 percent of patients before first-line therapy, with slightly lower rates in North America (77 percent). In 2016, 18 percent of requested results were not received before initiating treatment, a significant drop since 2015 when results were not received in time for 23 percent of requests. In the 2016 survey, respondents were asked how quickly results were available and for the majority of EGFR tests, results were available within 10 business days. However, nearly one-quarter of test results were received later.

Excluding tumor histology, in 2016, the main reasons for not testing included insufficient tissue (63 percent), poor performance status (40 percent), not believing results would impact therapy decisions (21 percent), and long turnaround time (21 percent). Notably the excuse of turnaround time significantly dropped from 30 percent in 2015.

“Although the two surveys do show a year-on-year improvement, some patients with advanced lung cancer carrying activating EGFR mutations appear to receive care that is not in line with current evidence and guidelines,” conclude the authors led by Matthew Peters, M.D., from Macquarie University in Australia. The study was funded by the pharmaceutical company Boehringer Ingelheim.

Takeaway: While progress has been made in EGFR testing to drive targeted treatment for NSCLC, adoption of testing guidelines remains far from universal.