Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
Adv Ther. 2022 Jul;39(7):3347-3360. doi: 10.1007/s12325-022-02189-z. Epub 2022 Jun 8.
Approximately 15% of patients with non-small cell lung cancer (NSCLC) harbor an epidermal growth factor receptor mutation (EGFRm). Mutation testing (including EGFRm) is recommended for patients with advanced NSCLC (aNSCLC) prior to initiating first-line therapy (L1) or after progression on targeted therapy. To elucidate current and future unmet needs, the present study characterized real-world EGFR testing patterns and treatment patterns in patients with aNSCLC.
This retrospective observational cohort study evaluated newly diagnosed adult patients with aNSCLC (stage IIIB or higher) from the Flatiron Health database. Eligible patients received at least L1 during 2015-2020 (testing cohorts) or 2011-2020 (treatment cohorts). Eligible patients for the treatment cohorts had an EGFR mutation.
The testing cohort included 22,726 patients, 75.5% had at least one EGFR test and 15.2% of those tested were positive for EGFR mutation. From 2015 to 2020, the median time from sample collection to test results decreased substantially while the proportion of NGS EGFR tests and use of plasma samples increased. The treatment cohort included 3701 patients (95% common mutations [cEGFR], 5.0% exon 20 insertions [ex20ins]). Three or more lines of therapy (LOTs) were observed in approximately 30% of patients. For L1, most cEGFR patients received EGFR tyrosine kinase inhibitors (EGFR-TKI, 68.1%) or platinum-based chemotherapy (PBC, 24.8%); most ex20ins patients received PBC (66.1%) or EGFR-TKI (17.5%). The most common L2 was EGFR-TKI (54.1%) or PBC (22.8%) for cEGFR and immunotherapy (25.9%) or PBC (25.9%) for ex20ins. No predominant L3 was evident in either group.
This real-world study, among the largest analyses of testing patterns for patients with aNSCLC, demonstrates a comprehensive view of treatment patterns for patients with EGFR mutations, including ex20ins. Despite recent improvement, increased use of EGFR testing, including advanced methods, is needed to optimize treatment pathways and outcomes. Additionally, the lack of a predominant therapy in later lines indicates a need for new therapies.
约 15%的非小细胞肺癌（NSCLC）患者存在表皮生长因子受体突变（EGFRm）。在开始一线治疗（L1）或靶向治疗进展后，建议对晚期 NSCLC（aNSCLC）患者进行突变检测（包括 EGFRm）。为了阐明当前和未来的未满足需求，本研究描述了 aNSCLC 患者的真实世界 EGFR 检测模式和治疗模式。
本回顾性观察性队列研究评估了来自 Flatiron Health 数据库的新诊断的 aNSCLC（IIIB 期或更高期）成年患者。合格患者在 2015-2020 年期间（检测队列）或 2011-2020 年期间（治疗队列）接受了至少一次 L1 治疗。治疗队列的合格患者存在 EGFR 突变。
检测队列包括 22726 名患者，75.5%至少进行了一次 EGFR 检测，其中 15.2%的检测结果呈 EGFR 突变阳性。从 2015 年到 2020 年，样本采集到检测结果的中位时间大大缩短，而 NGS EGFR 检测的比例和使用血浆样本的比例增加。治疗队列包括 3701 名患者（95%常见突变 [cEGFR]，5.0%外显子 20 插入 [ex20ins]）。约 30%的患者接受了 3 线或以上的治疗（LOTs）。对于 L1，大多数 cEGFR 患者接受了 EGFR 酪氨酸激酶抑制剂（EGFR-TKI，68.1%）或铂类化疗（PBC，24.8%）；大多数 ex20ins 患者接受了 PBC（66.1%）或 EGFR-TKI（17.5%）。对于 cEGFR，最常见的 L2 是 EGFR-TKI（54.1%）或 PBC（22.8%），而对于 ex20ins，最常见的是免疫疗法（25.9%）或 PBC（25.9%）。在两组中都没有明显的主导 L3。
这项真实世界的研究是对 aNSCLC 患者检测模式的最大分析之一，展示了 EGFR 突变患者治疗模式的全面视图，包括 ex20ins。尽管最近有所改善，但仍需要更多地进行 EGFR 检测，包括使用先进方法，以优化治疗途径和结果。此外，在后面的治疗线中没有明显的主导疗法表明需要新的疗法。
