Real-World Data on EGFR and ALK Testing and TKI Usage in Norway-A Nation-Wide Population Study

Inger Johanne Zwicky Eide; Yngvar Nilssen; Elin Marie Stensland; Odd Terje Brustugun

doi:10.3390/cancers15051505

Real-World Data on EGFR and ALK Testing and TKI Usage in Norway-A Nation-Wide Population Study

Cancers (Basel). 2023 Feb 27;15(5):1505. doi: 10.3390/cancers15051505.

Authors

Inger Johanne Zwicky Eide^{1

2}, Yngvar Nilssen³, Elin Marie Stensland^{1

2}, Odd Terje Brustugun^{1

2}

Affiliations

¹ Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, N-3004 Drammen, Norway.
² Institute of Clinical Medicine, University of Oslo, N-0316 Oslo, Norway.
³ Cancer Registry of Norway, N-0304 Oslo, Norway.

Abstract

Clinical studies have shown the efficacy of EGFR- and ALK-directed therapies in non-small cell lung cancer (NSCLC). Real-world data on, e.g., testing patterns, uptake, and duration of treatment are scarce. Reflex EGFR and ALK testing of non-squamous NSCLCs were implemented in Norwegian guidelines in 2010 and 2013, respectively. We present a complete national registry data on incidence, pathology procedures, and drug prescription in the period of 2013 to 2020. Test rates for both EGFR and ALK increased over time and were 85% and 89%, respectively, at the end of the study period, independent of age up to 85 years. The positivity rate for EGFR was higher among females and young patients, whereas no sex difference was observed for ALK. EGFR-treated patients were older than ALK-treated patients (71 vs. 63 years at start, p < 0.001). Male ALK-treated patients were significantly younger than females at the start of treatment (58 vs. 65 years, p = 0.019). The time from the first dispensation to the last dispensation of TKI (as a surrogate for progression-free survival) was shorter for EGFR- than for ALK-TKI, and survival for both EGFR- and ALK-positive patients was substantially longer than for non-mutated patients. We found a high adherence to molecular testing guidelines, good concordance of mutation positivity and treatment, and the real-world replication of findings in clinical trials, indicating that the relevant patients are provided substantially life-prolonging therapy.

Keywords: ALK; EGFR; non-small cell lung cancer; population-based study; registry; survival.

Grants and funding

This research was funded by the South-Eastern Norway Regional Health Authority, research grant no. 2021012, awarded to I.J.Z.E., and research grant no. 2018049, awarded to O.T.B.