EGFR-mutation testing and TKI treatment patterns in locally advanced and metastatic NSCLC in Norway - A nationwide retrospective cohort study

Åslaug Helland; Klaus Kaae Andersen; Tor Åge Myklebust; Tom Børge Johannesen; Jørgen Aarøe; Espen Enerly

doi:10.1016/j.ctarc.2022.100636

EGFR-mutation testing and TKI treatment patterns in locally advanced and metastatic NSCLC in Norway - A nationwide retrospective cohort study

Cancer Treat Res Commun. 2022:33:100636. doi: 10.1016/j.ctarc.2022.100636. Epub 2022 Sep 16.

Authors

Åslaug Helland¹, Klaus Kaae Andersen², Tor Åge Myklebust³, Tom Børge Johannesen⁴, Jørgen Aarøe⁵, Espen Enerly⁶

Affiliations

¹ Department of Cancer Genetics, Institute of Cancer Research, Oslo University Hospital, Oslo, Norway; Department of Oncology, Oslo University Hospital, Norway.
² Medical, Biopharmaceuticals, AstraZeneca Nordic, Copenhagen, Denmark.
³ Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway; Department of Registration, Cancer Registry of Norway, Oslo, Norway.
⁴ Department of Registration, Cancer Registry of Norway, Oslo, Norway.
⁵ Medical, Biopharmaceuticals, AstraZeneca of Nordic, Oslo, Norway.
⁶ Department of Research, Cancer Registry of Norway, Oslo, Norway. Electronic address: espen.enerly@kreftregisteret.no.

PMID: 36155129
DOI: 10.1016/j.ctarc.2022.100636

Abstract

Background: Testing for epidermal growth factor receptor mutation (EGFRm) status is a prerequisite to identify eligible patients for tyrosine kinase inhibitors (TKI) treatment. However, EGFR testing of patients with non-small cell lung cancer (NSCLC) is suboptimal in many parts of the world. The aim of this study was to describe real-world EGFR testing practice, EGFRm prevalence, and subsequent TKI treatment patterns in Norway.

Patients and methods: This retrospective, observational, cohort study included all incident locally advanced and metastatic non-squamous NSCLC patients registered in the Norwegian Cancer Registry during 2010-2017. A cohort with follow-up through 2018 was formed with linkage to nationwide registries on comorbidities, prescribed drugs and causes-of-death.

Results: A total of 10,717 patients were included, of which 35% (3782) with locally advanced NSCLC and 65% (6935) with metastatic disease. Mean age at diagnosis was 71 years and 47% were female. EGFR testing among patients with metastatic NSCLC increased from 41% to >64% between 2010 and 2017, with a relative stable incidence of EGFRm+ (∼9%). More than 85% of EGFRm+ patients received TKI treatment. Patients with the most dismal prognosis (>80 age, comorbidities) and with diagnosis based on cytology/imaging were less likely to be tested. Differences in testing were observed between regions.

Conclusion: Despite increased test rates over the study period, in Norway, a significant proportion of patients with non-squamous metastatic NSCLC are still not tested for EGFR. To maximize the identification of eligible patients for targeted therapies, increased testing is recommended, regardless of age, comorbidity rate and place of residence.

Keywords: Epidermal growth factor receptor; Non-small cell lung cancer; Tyrosine kinase inhibitors.

Publication types

Observational Study

MeSH terms

Carcinoma, Non-Small-Cell Lung* / drug therapy
Carcinoma, Non-Small-Cell Lung* / genetics
Carcinoma, Non-Small-Cell Lung* / pathology
Cohort Studies
ErbB Receptors* / genetics
Female
Genetic Testing* / methods
Genetic Testing* / trends
Humans
Lung Neoplasms / drug therapy
Lung Neoplasms / genetics
Lung Neoplasms / pathology
Male
Mutation
Norway / epidemiology
Protein Kinase Inhibitors / pharmacology
Protein Kinase Inhibitors / therapeutic use
Retrospective Studies
Tyrosine Kinase Inhibitors* / pharmacology
Tyrosine Kinase Inhibitors* / therapeutic use

Substances

EGFR protein, human
ErbB Receptors
Protein Kinase Inhibitors
Tyrosine Kinase Inhibitors