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A Delphi consensus panel about clinical management of early-stage EGFR-mutated non-small cell lung cancer (NSCLC) in
Dolores Isla1, Enriqueta Felip2, Pilar Garrido3
1Hospital Universitario Lozano Blesa, IIS Aragón, Saragossa, Spain.
Purpose:
This Delphi panel study assessed the level of consensus between medical oncologists on the clinical management of patients with early-stage EGFR-mutated non-small cell lung cancer (NSCLC).
Methods:
A modified two-round Delphi approach was used. A scientific committee comprised of medical oncologists developed an online questionnaire. Delphi panel experts rated their level of agreement with each questionnaire statement on a 9-point Likert scale. The questionnaire included 36 statements from 3 domains (clinical management of early-stage NSCLC: 15 statements; role of adjuvant therapy in early-stage NSCLC: 9 statements; and role of adjuvant therapy in early-stage NSCLC with sensitizing EGFR mutation: 12 statements).
Results:
In round 1, consensus was reached for 24/36 statements (66.7%). Nine statements that did not achieve consensus after the first round were evaluated in round 2, and none of them reached consensus. Overall, 84.4% of the panelists agreed that EGFR mutation testing should be done after surgery. Consensus was not achieved on whether the implementation of EGFR mutation testing in resected early-stage NSCLC could limit the use of adjuvant osimertinib. The panelists recognized the rationale for the use of osimertinib in the adjuvant scenario (88%) and 72% agreed that it may change the treatment paradigm in stage IB-IIIA EGFR-mutated NSCLC. Consensus was not reached on the inconvenience of prolonged duration of osimertinib.
Conclusions:
This Delphi study provides valuable insights into relevant questions in the management of early-stage EGFR-mutated NSCLC. However, specific issues remain unresolved. The expert consensus emphasizes the role of adjuvant treatment with osimertinib in this scenario.
Insights
Medical oncologists reached consensus on many aspects of early-stage EGFR-mutated non-small cell lung cancer (NSCLC) management, including adjuvant osimertinib. However, some key questions regarding its use and duration remain unresolved.
Area of Science:
- Oncology
- Thoracic Surgery
- Medical Genetics
Background:
- Non-small cell lung cancer (NSCLC) with EGFR mutations presents unique treatment challenges.
- Early-stage NSCLC management requires clear guidelines for optimal patient outcomes.
- Adjuvant therapy plays a crucial role in preventing recurrence in resected NSCLC.
Purpose of the Study:
- To assess expert consensus among medical oncologists regarding the clinical management of early-stage NSCLC with EGFR mutations.
- To identify areas of agreement and disagreement on adjuvant therapy strategies, specifically involving osimertinib.
Main Methods:
- A modified two-round Delphi approach was employed.
- Medical oncologists rated agreement on 36 statements via an online questionnaire.
- Statements covered clinical management, adjuvant therapy, and adjuvant osimertinib in EGFR-mutated NSCLC.
Main Results:
- Consensus was achieved on 66.7% of statements after round 1; no consensus was reached on remaining statements in round 2.
- 84.4% agreed on post-surgery EGFR mutation testing.
- Consensus was not reached on whether EGFR testing limits adjuvant osimertinib use, but experts recognized its rationale (88%) and potential to change treatment paradigms (72%).
Conclusions:
- The Delphi study offers insights into managing early-stage EGFR-mutated NSCLC, highlighting areas of agreement.
- Unresolved issues persist, particularly concerning adjuvant osimertinib's implementation and duration.
- Expert consensus supports the role of adjuvant osimertinib in this patient population.
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