Lung Cancer in the Netherlands

Hendriks, Lizza; Dingemans, Anne‐Marie C.; Ruysscher, Dirk K.M. De; Aarts, Mieke J.; Barberio, Lidia; Cornelissen, Robin; Hartemink, Koen J.; Heuvel, Michel van den; Schuuring, Ed; Smit, Hans; Wekken, A.J. van der; Smit, Egbert F.

doi:10.1016/j.jtho.2020.10.012

Cited by 15 publications

(13 citation statements)

References 33 publications

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“…In the period 2013–2017, EGFR mutation testing in the Netherlands has transformed from a single-gene approach to the nationwide implementation of NGS using a multigene panel for predictive biomarker testing including EGFR according to the current Dutch national guideline for lung cancer [ 10 ]. This shift did not affect the overall detection rate of EGFR mutations (11.7%) nor the distribution of mutations.…”

Section: Discussionmentioning

confidence: 99%

“…improves survival of advanced NSCLC patients with EGFR exon 19 deletions and L858R point mutations. Therefore, molecular diagnostics to detect these and other EGFR mutations has been standard-of-care in Europe since 2010 [ 8 , 9 , 10 ]. Molecular testing has since evolved from a single-gene polymerase chain reaction-based approach to the implementation of multiplex analyses such as next-generation sequencing (NGS) in routine diagnostics for the detection of multiple gene variants in a limited amount of tissue [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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A Nationwide Study on the Impact of Routine Testing for EGFR Mutations in Advanced NSCLC Reveals Distinct Survival Patterns Based on EGFR Mutation Subclasses

Koopman

Garcia

Kuijpers³

et al. 2021

Cancers

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EGFR mutation analysis in non-small-cell lung cancer (NSCLC) patients is currently standard-of-care. We determined the uptake of EGFR testing, test results and survival of EGFR-mutant NSCLC patients in the Netherlands, with the overall objective to characterize the landscape of clinically actionable EGFR mutations and determine the role and clinical relevance of uncommon and composite EGFR mutations. Non-squamous NSCLC patients diagnosed in 2013, 2015 and 2017 were identified in the Netherlands Cancer Registry (NCR) and matched to the Dutch Pathology Registry (PALGA). Overall, 10,254 patients were included. Between 2013–2017, the uptake of EGFR testing gradually increased from 72.7% to 80.9% (p < 0.001). Multi-gene testing via next-generation sequencing (increased from 7.8% to 78.7% (p < 0.001), but did not affect the number of detected EGFR mutations (n = 925; 11.7%; 95% confidence interval (CI), 11.0–12.4) nor the distribution of variants. For patients treated with first-line EGFR inhibitors (n = 651), exon 19 deletions were associated with longer OS than L858R (HR 1.58; 95% CI, 1.30–1.92; p < 0.001) or uncommon, actionable variants (HR 2.13; 95% CI, 1.60–2.84; p < 0.001). Interestingly, OS for patients with L858R was similar to those with uncommon, actionable variants (HR 1.31; 95% CI, 0.98–1.75; p = 0.069). Our analysis indicates that grouping exon 19 deletions and L858R into one class of ‘common’ EGFR mutations in a clinical trial may mask the true activity of an EGFR inhibitor towards specific mutations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Nationwide Study on the Impact of Routine Testing for EGFR Mutations in Advanced NSCLC Reveals Distinct Survival Patterns Based on EGFR Mutation Subclasses

Koopman

Garcia

Kuijpers³

et al. 2021

Cancers

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“…Based on the large number of actionable mutations and available targeted therapies, clinical decision-making for patients with NSCLC can be particularly challenging. In many countries, multidisciplinary tumour boards (MDTBs) comprising healthcare professionals from diverse specialties are mandatory for the management of all patients with newly diagnosed NSCLC; molecular tumour boards (MTBs) may also be required to discuss complicated cases with rare mutations or complex mutational profiles [ 47 , 49 ]. In addition to interpreting molecular findings in relation to the sample quality (e.g.…”

Section: Reporting Of Biomarker Resultsmentioning

confidence: 99%

Expert opinion on NSCLC small specimen biomarker testing — Part 2: Analysis, reporting, and quality assessment

et al. 2022

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The diagnostic work-up for non-small cell lung cancer (NSCLC) requires biomarker testing to guide therapy choices. This article is the second of a two-part series. In Part 1, we summarised evidence-based recommendations for obtaining and processing small specimen samples (i.e. pre-analytical steps) from patients with advanced NSCLC. Here, in Part 2, we summarise evidence-based recommendations relating to analytical steps of biomarker testing (and associated reporting and quality assessment) of small specimen samples in NSCLC. As the number of biomarkers for actionable (genetic) targets and approved targeted therapies continues to increase, simultaneous testing of multiple actionable oncogenic drivers using next-generation sequencing (NGS) becomes imperative, as set forth in European Society for Medical Oncology guidelines. This is particularly relevant in advanced NSCLC, where tissue specimens are typically limited and NGS may help avoid tissue exhaustion compared with sequential biomarker testing. Despite guideline recommendations, significant discrepancies in access to NGS persist across Europe, primarily due to reimbursement constraints. The use of increasingly complex testing methods also has implications for the reporting of results. Molecular testing reports should include clinical interpretation with additional commentary on sample adequacy as appropriate. Molecular tumour boards are recommended to facilitate the interpretation of complex genetic information arising from NGS, and to collaboratively determine the optimal treatment for patients with NSCLC. Finally, whichever testing modality is employed, it is essential that adequate internal and external validation and quality control measures are implemented.

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“…The implementation of population-based lung cancer screening of high-risk individuals could decrease the percentage of inoperable patients who are diagnosed with stage III (21%) and IV (49%) lung cancer. A Dutch-initiated randomized lung cancer screening trial, known as the NELSON trial, has recently proven to result in a decrease in lung cancer mortality by 26% and to be cost-effective in the Netherlands (67)(68)(69). Although lung cancer screening programs are currently implemented in several European centers (70), screening for lung cancer with low-dose computed tomography is presently not yet implemented in the Netherlands because of legal restrictions (67).…”

Section: Lung Cancer Screening Of High-risk Individualsmentioning

confidence: 99%

Thoracic surgery in the Netherlands

Laven¹,

Daemen²,

Jansen³

et al. 2022

J Thorac Dis

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The purpose of this article, part of the Thoracic Surgery Worldwide series, is to provide a descriptive review of how thoracic surgery is organized in the Netherlands. General information is provided on the Dutch healthcare system, as well as on how Dutch thoracic surgeons are organized and trained.Additionally, this study provides information on our national quality surveillance system, an overview of the most common thoracic surgeries performed in our country, and details of academic research conducted by Dutch medical specialists. Furthermore, we discuss current challenges and future perspectives. In the Netherlands general thoracic surgical procedures are performed by approximately 110 general thoracic surgeons and 25 of the 135 cardiothoracic surgeons. Dutch thoracic surgeons provide minimally invasive lung surgery, chest wall surgery, thymic and mediastinal surgery, and surgical diagnosis and treatment of pleural disorders. Some recently published data on hospital mortality and postoperative adverse events of thoracic surgeries are reported. Furthermore, the structure of the thoracic surgical education and training program is discussed, highlighting the particular structure of two educational programs for thoracic surgery via a general thoracic and cardiothoracic surgery program. To assure high-quality surgical care, the Netherlands has a well-structured national quality surveillance system, involving frequent site visits and mandatory participation in the national lung cancer surgery registry for all hospitals. In terms of academic research, the Netherlands ranked 14th worldwide on number of clinical trials conducted across all medical disciplines in 2021. Furthermore, several thoracic-related (inter-)national multicenter randomized trials which are currently performed and initiated by Dutch hospital research groups are mentioned. Finally, future challenges and advances of Dutch thoracic surgery are addressed, including the implementation of lung cancer screening, imbalanced labor market, and centralization of care.

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Lung Cancer in the Netherlands

Cited by 15 publications

References 33 publications

A Nationwide Study on the Impact of Routine Testing for EGFR Mutations in Advanced NSCLC Reveals Distinct Survival Patterns Based on EGFR Mutation Subclasses

A Nationwide Study on the Impact of Routine Testing for EGFR Mutations in Advanced NSCLC Reveals Distinct Survival Patterns Based on EGFR Mutation Subclasses

Expert opinion on NSCLC small specimen biomarker testing — Part 2: Analysis, reporting, and quality assessment

Thoracic surgery in the Netherlands

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