Epidermal growth factor receptor and anaplastic lymphoma kinase testing and mutation prevalence in patients with advanced non-small cell lung cancer in Switzerland: A comprehensive evaluation of real world practices

Abstract

In order to improve outcomes, identification of the epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) genes has become crucial in advanced non-small-cell lung cancer (NSCLC). The aim of the present study is to analyse time trends and frequency of testing, factors affecting testing as well as prevalence of mutations in the Swiss population. We analysed EGFR and ALK testing in a cohort of patients with newly diagnosed metastasised non-squamous NSCLC in the catchment area of the cancer registry Eastern Switzerland in the years 2008-2014. We analysed prevalence of mutations and studied clinicopathological characteristics and survival of tested and non-tested patients and of patients with and without mutations. Among 718 patients identified, 11% (51/447) harboured an EGFR mutation in the exons 18, 19 or 21 and further 12% (31/265) showed a positive test result for ALK rearrangements. In non-smokers the proportions of mutations were 31% and 23% respectively. Testing rates increased over time and reached 79% in 2014. We observed significantly lower testing rates and poorer survival in elderly, patients with limited life expectancy and patients treated at hospitals not involved in clinical research. Outcomes can be further improved in a considerable proportion of patients with advanced non-squamous NSCLC.

Real-world treatment patterns and survival outcomes for advanced non-small cell lung cancer in the pre-immunotherapy era in Portugal: a retrospective analysis from the I-O Optimise initiative

“…Of the patients at IPO-Porto with NSQ who were tested for EGFR or ALK mutations/rearrangements, 20.1 and 8.8%, respectively, were found to have mutations/rearrangements. These rates are comparable to those reported in several observational studies conducted in Portugal and elsewhere in Europe in which rates ranged from 10 to 28% for EGFR mutations [15][16][17][18][23][24][25][26][27], and from 3 to 12% for ALK rearrangements [17,24].…”

Does progress achieved in the treatment of patients with metastatic non‐small‐cell lung cancer reach the elderly population? A cohort study from a cancer centre from Eastern Switzerland

“…Testing for EGFR mutations as ALK rearrangements with consecutive targeted treatment has become standard practice in Switzerland after 2009 and 2013 respectively. However, lower testing rates and poorer survival in the elderly have been recently observed by our own group (Ess et al, ).…”

“…However, lower testing rates and poorer survival in the elderly have been recently observed by our own group (Ess et al, 2017).…”

Ultrarapid EGFR Mutation Screening Followed by Comprehensive Next-Generation Sequencing: A Feasible, Informative Approach for Lung Carcinoma Cytology Specimens With a High Success Rate

“…6 Barriers to testing identified by US and global surveys include insufficient tissue for testing, relatively long turnaround times (TATs), lack of local molecular testing, and poor performance status of patients. [7][8][9][10][11][12][13][14][15][16][17][18] Given the growing number of actionable targets in NSCLC, current guidelines 2 support the position that upfront comprehensive next-generation sequencing (NGS) is more practical than performing a series of single-gene assays. Recent advances in checkpoint immunotherapy further underscore the need for more comprehensive NGS testing to accurately assess new markers, such as tumor mutation burden, mutational signatures, and microsatellite instability.…”