Personalized treatments for lung cancer underused: International survey

Despite the majority of newly diagnosed advanced non-small cell lung cancer (NSCLC) patients being tested for genetic mutations, a gap still exists for providing a personalized treatment plan for patients based on their cancer type and mutation subtype, according to an international survey presented as a late-breaking abstract in the ESMO-IASLC Best Abstracts session at the 2015 European Lung Cancer Conference in Geneva, Switzerland.

An international survey, sponsored by Boehringer Ingelheim, found that 60% of US oncologists do not determine their treatment decision based on patient’s genetic mutation subtype, compared with 50% in Canada and 23% in Asia.

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According to the survey, for more than 1 in 4 US lung cancer patients tested for epidermal growth factor receptor (EGFR) mutations, results were not available at the time of the treatment decision, compared to 30% in Europe and 12% in Asia. For those patients who were not tested, the main reasons, aside from tumor histology, were insufficient tissue/uncertainty of sufficient tissue, poor performance status and test results taking too long to come back. 

Dr Kim“The survey shows that the majority of oncologists are not making treatment decisions based on patients’ genetic information,” said Edward Kim, MD, with the Levine Cancer Institute, Carolinas HealthCare System in Charlotte, N.C. “However, joint guidelines from leading organizations recommend that doctors should order EGFR genetic testing at the time of diagnosis for patients with advanced NSCLC regardless of their clinical history.”

EGFR mutations occur in about 10% to 15% of NSCLC cases, according to Dr Kim.

“The guidelines, based on the latest clinical evidence, were developed to help oncologists and pathologists put genetic testing into practice,” he said. “By following guidelines, healthcare providers will be better able to select the right treatment at the right time to patients with the ultimate goal of improving outcomes.”

There is still work to be done in emphasizing the importance of obtaining EGFR test results prior to the initiation of treatment, and using this vital information to select appropriate therapy, according to Dr Kim.

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“Treatment guidelines recommend that EGFR mutation testing should be performed at diagnosis of NSCLC and results should guide treatment decisions to ensure all patients receive appropriate therapy according to their specific cancer type,” said Dr Kim.

The survey included 562 physicians from 10 countries, including Canada, France, Germany, Italy, Japan, South Korea, Spain, Taiwan, United Kingdom and United States. The online survey took place between December 2014 and January 2015 and included 14 questions that assessed the prevalence of EGFR mutation testing, barriers to testing and how test results affect treatment decisions.

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