Subramanian Janakiraman, Leighl Natasha B, Choi Yoon-La, Chou Teh-Ying, Gregg Jeffrey, Hui Rina, Marchetti Antonio, Silvey Mark, Makin Rebecca, Gillespie-Akar Liane, Taylor Aliki, Kahangire Doreen A, Bailey Tom, Chau Maiyan, Navani Neal
Inova Schar Cancer Institute, Fairfax, VA, USA.
Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Lung Cancer. 2023 Jan;175:47-56. doi: 10.1016/j.lungcan.2022.11.009. Epub 2022 Nov 17.
Epidermal growth factor receptor (EGFR) mutations (EGFRm) are common oncogene drivers in non-small cell lung cancer (NSCLC). This real-world study explored treatment patterns and time to receive EGFRm test results in patients with advanced EGFRm NSCLC.
A cross-sectional medical chart review was completed May-August 2020 in Australia, Canada, Germany, Italy, South Korea, Taiwan, UK, and USA. Eligible patients had advanced NSCLC and a positive EGFRm test result January-December 2017. Data were abstracted from NSCLC diagnosis to end of follow-up (31 March 2020) or patient's death whichever occurred earlier. The index date was the date of EGFRm confirmation.
223 physicians provided data for 1,793 patients. Patients' mean age was 64.7 years, 54 % were male, 30.7 % had no history of smoking. Overall, 78 % of EGFRm test results were received ≤ 2 weeks after request (range of median 7-14 days across countries). Median time from advanced NSCLC diagnosis to EGFRm test result was 18 days (median range 10-22 days across countries). Over a third (37 %) of patients received a systemic treatment prior to EGFRm result; chemotherapy (25 %) and EGFR-TKI (15 %) were most commonly prescribed; post-EGFR test-result was EGFR-TKI (68 %); 80 % of patients initiated EGFR-TKI at any time point post-NSCLC diagnosis. Of those receiving a first-line EGFR-TKI post-EGFRm testing, 84 % received a TKI alone, 12 % in combination with chemotherapy, and 3 % with other treatments. Median time from first-line EGFR-TKI initiation post-EGFRm testing to first subsequent treatment was 19.8 months.
Over one-fifth of patients wait >14 days for their EGFRm test results, affecting their likelihood of receiving first-line EGFR-TKI with 20 % of patients never receiving EGFR TKI treatment. There was significant inter-country variability in the proportion of patients receiving EGFR TKIs. Our study highlights the need to improve EGFRm testing turnaround times and treatment initiation across countries.
表皮生长因子受体（EGFR）突变（EGFRm）是非小细胞肺癌（NSCLC）中常见的致癌基因驱动因素。这项真实世界研究探讨了晚期EGFRm NSCLC患者的治疗模式以及获得EGFRm检测结果的时间。
2020年5月至8月在澳大利亚、加拿大、德国、意大利、韩国、中国台湾地区、英国和美国完成了一项横断面病历回顾研究。符合条件的患者为2017年1月至12月患有晚期NSCLC且EGFRm检测结果呈阳性的患者。数据从NSCLC诊断记录至随访结束（2020年3月31日）或患者死亡，以先发生者为准。索引日期为EGFRm确认日期。
223名医生提供了1793例患者的数据。患者的平均年龄为64.7岁，54%为男性，30.7%无吸烟史。总体而言，78%的EGFRm检测结果在申请后≤2周内获得（各国中位数范围为7 - 14天）。从晚期NSCLC诊断到EGFRm检测结果的中位时间为18天（各国中位数范围为10 - 22天）。超过三分之一（37%）的患者在获得EGFRm结果之前接受了全身治疗；最常开具的是化疗（25%）和EGFR-TKI（15%）；EGFR检测结果出来后使用EGFR-TKI的患者占68%；80%的患者在NSCLC诊断后的任何时间点开始使用EGFR-TKI。在EGFRm检测后接受一线EGFR-TKI治疗的患者中，84%仅接受TKI治疗，12%与化疗联合使用，3%与其他治疗联合使用。从EGFRm检测后一线EGFR-TKI开始使用到首次后续治疗的中位时间为19.8个月。
超过五分之一的患者等待EGFRm检测结果的时间超过14天，这影响了他们接受一线EGFR-TKI治疗的可能性，20%的患者从未接受过EGFR TKI治疗。各国接受EGFR TKIs治疗的患者比例存在显著差异。我们的研究强调需要在各国提高EGFRm检测周转时间和治疗起始时间。
