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Detection of Targetable Alterations in Non-small Cell Lung Cancer using Next-generation Sequencing
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Treatment Patterns by EGFR Mutation Status in Non-Small Cell Lung Cancer Patients in the USA: A Retrospective

Kathleen M Aguilar1, Katherine B Winfree2, Catherine E Muehlenbein3

  • 1McKesson Specialty Health, Woodlands, TX, USA.

Advances in Therapy
|October 21, 2018
PubMed
Abstract

Insights

This study analyzed real-world treatment patterns for non-small cell lung cancer (NSCLC) in the US. Most EGFR-positive patients received first-line erlotinib, but many did not advance to second-line therapy.

Area of Science:

  • Oncology
  • Pharmacology
  • Clinical Research

Background:

  • Targeted therapies like tyrosine kinase inhibitors (TKIs) are recommended for EGFR-mutant non-small cell lung cancer (NSCLC).
  • Resistance to TKIs is common in EGFR-mutant NSCLC patients.
  • Optimal treatment sequencing for EGFR-mutant NSCLC remains unclear, with limited real-world data on TKI use patterns.

Purpose of the Study:

  • To evaluate national-level, real-world treatment patterns for non-small cell lung cancer (NSCLC) in the USA.
  • To assess TKI treatment use irrespective of EGFR mutation status.
  • To provide insights into treatment sequencing and utilization in a large patient cohort.

Main Methods:

  • Retrospective observational study using the US Oncology Network's iKnowMed database.
  • Included patients with advanced NSCLC initiating first-line erlotinib and/or chemotherapy (Jan 2012–Jun 2015).
  • Descriptive analyses of demographic, clinical characteristics, and treatment patterns, stratified by EGFR status.

Main Results:

  • 3108 patients identified; 18.5% EGFR positive, 49.8% EGFR negative, 31.7% unknown EGFR status.
  • First-line erlotinib monotherapy used in 18.4% of the overall cohort and 77.8% of EGFR-positive patients.
  • Less than 1% received first-line combination therapy; ~4-5% received second-line erlotinib; nearly two-thirds did not advance to second-line therapy.

Conclusions:

  • Real-world treatment patterns observed are generally consistent with NCCN guidelines.
  • Further research is needed to understand optimal therapy sequencing and its impact on outcomes in NSCLC.
  • The study highlights significant utilization of first-line erlotinib in EGFR-positive NSCLC but a gap in subsequent treatment escalation.
Keywords:
Epidermal growth factor receptorErlotinibNon-small cell lung cancerOncologyReal-world evidenceTreatment patternsTyrosine kinase inhibitor

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