Research Department of Practice and Policy, School of Pharmacy, University College London (UCL), London, United Kingdom.
University College London Hospitals (UCLH) National Health Service (NHS) Foundation Trust/University College London Hospital-UCL Centre for Medicines Optimisation Research and Education, Cancer Division, London, United Kingdom.
JCO Oncol Pract. 2020 Aug;16(8):e770-e778. doi: 10.1200/JOP.19.00507. Epub 2020 Mar 11.
The growth in understanding of molecular biology and genomics has augmented the development of targeted cancer treatments; however, challenges exist in access to molecular testing, an essential precursor to treatment decision-making. We used data from a cross-sectional survey to evaluate the differences in uptake of molecular testing.
Using the aggregated results of a questionnaire developed and distributed to clinicians by IQVIA, including treatment details and investigations undertaken for patients, we compared proportions of patients receiving molecular testing and targeted treatment by cancer type for the United Kingdom, France, Italy, Germany, Spain, South Korea, Japan, and China. We used multivariable logistic regression methods to understand the effect of country on the odds of receiving a molecular test.
There was a total of 61,491 cases. Across countries and cancer types, uptake rates for molecular testing ranged between 2% and 98%, with the greatest differences seen in gastric cancers (range, 23% to 70%), and significant variations were observed for both European and Asian countries. China consistently demonstrated a significantly reduced uptake for all molecular tests assessed; however; uptake of drug treatment in gastric cancers after testing positive for the human epidermal growth factor receptor 2 gene was higher than in some European countries (China, 85%; European range, 8% to 66%). The uptake of epidermal growth factor receptor gene testing was greater in some Asian countries relative to the United Kingdom, where incidence of lung cancer is higher (Japan: odds ratio, 3.1 [95% CI, 2.6 to 3.8]; South Korea: odds ratio, 2.7 [95% CI, 2 to 3.4]).
We have highlighted inequity in access to molecular testing and subsequent treatments across countries, which warrants improvements.
对分子生物学和基因组学的认识不断提高，促进了针对癌症的靶向治疗的发展；然而，在获得分子检测方面仍存在挑战，而这是治疗决策的重要前提。我们利用来自横断面调查的数据评估了不同国家在接受分子检测方面的差异。
我们使用了由 IQVIA 为临床医生开发和分发的问卷的汇总结果，其中包括针对患者的治疗细节和所进行的检查，我们比较了英国、法国、意大利、德国、西班牙、韩国、日本和中国的不同癌症类型患者接受分子检测和靶向治疗的比例。我们使用多变量逻辑回归方法来了解国家对接受分子检测几率的影响。
共有 61491 例患者。在不同国家和癌症类型中，分子检测的使用率在 2%到 98%之间，胃癌（范围 23%至 70%）的差异最大，欧洲和亚洲国家均存在显著差异。中国对所有评估的分子检测的使用率始终明显较低；然而，在人表皮生长因子受体 2 基因检测呈阳性后，对胃癌进行药物治疗的使用率高于一些欧洲国家（中国 85%；欧洲范围 8%至 66%）。在一些亚洲国家，表皮生长因子受体基因检测的使用率高于英国（日本：优势比 3.1 [95%CI 2.6 至 3.8]；韩国：优势比 2.7 [95%CI 2 至 3.4]）。
我们强调了不同国家在获得分子检测和随后治疗方面的不平等，这需要加以改进。
