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EGFR Mutation Testing of non-squamous NSCLC: Impact and Uptake during Implementation of Testing Guidelines in a Population-Based Registry Cohort from Northern New Zealand

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Abstract

Background

Since 2013, clinical practice guidelines recommend EGFR mutation testing of non-squamous NSCLC to select advanced-stage patients for first-line treatment using EGFR-TKIs.

Objective

We aimed to determine population-based trends in the real-world uptake and impact in routine practice of these recently updated testing guidelines.

Patients and Methods

A population-based observational study was conducted of notifications to the New Zealand Cancer Registry of patients eligible for EGFR testing diagnosed in northern New Zealand between January 2010 and April 2014. The main study variable was EGFR mutation testing. Main outcome measures (overall survival and dispensing of EGFR-TKIs) were extracted from prospectively archived electronic databases until October 2015.

Results

The population-based cohort of 1857 patients had an average age of 70 years. Most had adenocarcinoma and metastatic disease at diagnosis. EGFR testing was undertaken in 500 patients (27%) with mutations detected in 109 patients (22%). EGFR testing increased during the period of study from <5% to 67% of patients (P < 0.0001). Full uptake of testing by all eligible patients was limited by a lack of availability of specimens for testing and variable testing referral practices. The proportion of patients treated with EGFR-TKIs decreased during the same time period, both among untested patients (from 12.2% to 2.8% (P < 0.0001)) and in the population as a whole (from 13.7% to 10.6% (P < 0.05)). EGFR testing was associated with prolonged overall survival (Adjusted HR = 0.76 (95% CI, 0.65–0.89) Log-rank P < 0.0001) due at least in part to the much longer overall survival achieved by mutation-positive patients, of whom 79% received EGFR-TKIs. Compared to untested EGFR-TKI-treated patients, mutation-positive EGFR-TKI-treated patients received EGFR-TKIs for longer, and survived longer both from the start of EGFR-TKI treatment and date of their diagnosis.

Conclusions

In this real world setting, high uptake of EGFR testing was achieved and associated with major changes in EGFR-TKI prescribing and improved health outcomes. Modifiable factors determined testing uptake.

Study registration ACTRN12615000998549.

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Acknowledgements

We thank the many patients who contributed to this study. Maria Luisa Bituin contributed to the data collection. We thank the Health Research Council of New Zealand for their grant funding support (Project grants 13/981 and 15/087). Sandar Tin Tin was supported by the Auckland Medical Research Foundation/Perpetual David and Cassie Anderson Postdoctoral Fellowship and Kelliher Charitable Trust Emerging Researcher Start-up Award.

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Authors and Affiliations

  1. University of Auckland, Auckland, New Zealand

    Mark McKeage, Mark Elwood, Sandar Tin Tin, Prashannata Khwaounjoo, Phyu Aye, Angie Li & Phillip Shepherd

  2. Auckland City Hospital, Auckland, New Zealand

    Mark McKeage, Angie Li, George Laking & Christopher Lewis

  3. Department of Pharmacology and Clinical Pharmacology and Auckland Cancer Society Research Centre, School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road Grafton, Room 504-236A, Private Bag 92019, Auckland, 1142, New Zealand

    Mark McKeage

  4. LabPlus, Auckland City Hospital, Auckland, New Zealand

    Karen Sheath, Nicola Kingston & Donald Love

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  1. Mark McKeage
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Correspondence to Mark McKeage.

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Funding

The research was supported by grants from the Health Research Council of New Zealand (grant numbers 13/981 and 15/087).

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McKeage, M., Elwood, M., Tin Tin, S. et al. EGFR Mutation Testing of non-squamous NSCLC: Impact and Uptake during Implementation of Testing Guidelines in a Population-Based Registry Cohort from Northern New Zealand. Targ Oncol 12, 663–675 (2017). https://doi.org/10.1007/s11523-017-0515-4

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