Inequalities in lung cancer: a world ofEGFR

Abstract

Epidermal growth factor receptor gene (EGFR) mutation status has emerged as a crucial issue in lung cancer management. Availability and cost of tests and tyrosine kinase inhibitors (TKIs) may vary as a function of country development.We conducted a prospective specialist opinion survey to map EGFR test and EGFR-TKI availability and detect associations with the Human Development Index (HDI). A questionnaire was sent to specialists in thoracic oncology in all United Nations Member States.We obtained responses from 74 countries, comprising 78% of the worldwide population. Nonresponding countries had significantly lower HDI rank than responding countries. EGFR mutation analysis was routinely available in 57 countries (70% of the worldwide population). The cost of the test was <US$500 in 49 countries (42.5% of the worldwide population). Test availability and cost were both significantly linked to HDI. Erlotinib, gefitinib, afatinib and icotinib were routinely available in 75%, 66%, 31% and 23% of the worldwide population, respectively, also associated with HDI.EGFR mutation testing and EGFR-TKIs are widely accessible in routine practice worldwide. However, there are large discrepancies in access to this innovative treatment path and in its cost for patients as a function of country development.

The 5000% case: a glimpse into the financial issue of lung cancer treatment

“…In the present issue of European Respiratory Journal, CARBONNAUX et al [9] highlight two major financial issues, namely, as expected, cost in terms of access to the drug but primarily the cost in terms of access to molecular testing. Almost 10 years after the identification of the EGFR mutation [6,7], inequalities in the availability of the EGFR mutation test exist worldwide.…”

“…However, in a recent study, 50% of Asian patients with EGFR mutations were not female non-smokers [17]. Interestingly, CARBONNAUX et al [9] reported higher EGFR mutation positivity in Hispanic populations (30% in Mexico and 25% in Colombia) compared with Caucasian population (∼11%) [4]. Of note, although tobacco consumption has been related to molecular abnormalities (such as KRAS or STK11 mutations [18,19]), there are no aetiological findings that explain the occurrence of somatic EGFR mutations.…”

“…Drug expenditure accounted for ∼27% of cancer-related healthcare costs [23]. The heterogeneity of health insurance systems in European countries or in countries with the highest HDI is likely to explain (as reported by CARBONNAUX et al [9]) the difference in patient access to the main EGFR TKI (erlotinib, gefitinib and afatinib) and the variation of treatment costs between countries. The cost per patient for new anticancer drugs reaches $100,000 or more annually [24].…”

“…Almost 10 years after the identification of the EGFR mutation [6,7], inequalities in the availability of the EGFR mutation test exist worldwide. CARBONNAUX et al [9] have reported that EGFR mutational analysis was available for 70% of the world's population. Availability of the analysis, its cost and the delay for obtaining the results significantly correlated with the country's Human Development Index (HDI).…”

“…Although some studies suggest that EGFR TKI are cost-effective compared to standard first-line chemotherapy (cisplatin-pemetrexed) in advanced NSCLC patients [25], treatment costs are high. CARBONNAUX et al [9] reported a mean monthly out-of-pocket expense for these treatments of $500-$1000 per patient worldwide and it was even higher in the USA, reaching $1500. Moreover, contrary to chemotherapy that is prescribed for four to six cycles, EGFR TKIs are prescribed until disease progression.…”