Challenges to Implementation of an Epidermal Growth Factor Receptor Testing Strategy for Non-Small-Cell Lung Cancer in a Publicly Funded Health Care System.

Ellis PM, Verma S, Sehdev S, Younus J, Leighl NB.

Source

*Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, Ontario, Canada; †Medical Oncology Department, Odette Cancer Centre, Sunnybrook, Toronto, Ontario, Canada; ‡William Osler Cancer Centre, Brampton, Ontario, Canada; §Princess Margaret Hospital, London Regional Cancer Program, London, Ontario, Canada; and ‖Princess Margaret Hospital, Toronto, Ontario, Canada.

Abstract

BACKGROUND::

Data from seven recent randomized clinical trials have demonstrated that epidermal growth factor (EGFR) mutation status is predictive of improved progression-free survival and quality of life from first-line EGFR tyrosine kinase inhibitor therapy compared with platinum-based chemotherapy. We examined barriers to the initial implementation of a national EGFR testing policy in Canada.

METHODS::

Five laboratories across Canada underwent a validation and quality-control exercise for EGFR mutation testing using reverse transcriptase-polymerase chain reaction with financial support from the pharmaceutical industry for the initial 12 months. Oncologists registered patients with nonquamous histology for EGFR mutation testing using a Web-based platform. Basic demographics were collected including age, histology, sex, smoking status, and ethnicity. The decision to prescribe gefitinib was subsequently registered on the system.

RESULTS::

Between March and December 2010, 2104 requests were received for EGFR mutation testing. Demographic details are as follows: adenocarcinoma (91.6%); Asian ethnicity (13.9%); female (58%); light/never smoker (41.3%); stage IV disease (87.1%). The number of tests requested each month ranged from 200 to 250. Mutation testing was conducted in 1771 of 2104 requests (84%). The median turnaround time for EGFR testing was 18 days (standard deviation 9.7). Gefitinib was prescribed in 302 patients (17.1%). The number of test requests dropped to 50 to 100 per month at the end of the initial 12 months.

CONCLUSION::

There was rapid uptake of EGFR mutation testing into routine clinical practice in Canada. Uptake of EGFR mutation testing dropped substantially once funding from pharmaceutical industry was discontinued. There is a need for a national strategy to ensure resources are in place to implement molecular testing for new molecularly targeted agents.