By Edward Li, PharmD, BCOP, Drugs and Biologics Editor
At the recent 35th Congress of the European Society of Medical Oncology (ESMO) in Milan, Italy, a late-breaking abstract provided final overall survival (OS) results from the IPASS study (IRESSA Pan-Asia Study), which compared gefitinib to platinum-based chemotherapy for the treatment of first-line advanced Non-Small Cell Lung Cancer (NSCLC).i This study contributes to the discussion and debate about the role of EGFR mutation testing as part of the standard clinical work-up for patients presenting with NSCLC. Recently, an NCCN Trends™ Survey collected data about clinician EGFR mutation testing practices.
NCCN Trends™ is a survey-based data and analytics tool from NCCN that researches how clinicians in the United States and abroad deliver cancer care. NCCN Trends™ Surveys research questions about patterns of care and preferences for use of diagnostics, drugs and biologics, and other cancer treatment modalities.
Data is gathered by sending brief electronic surveys to the thousands of clinicians who use the NCCN website to access information. These clinicians include practicing physicians in many diverse practice settings, including academic/research cancer centers, community hospitals and private practices. NCCN Trends™ Surveys and Data are independent of any NCCN clinical recommendations or guidelines. Participants in the surveys receive a summary of survey results that offers insight into their own practice.
In July 2010, an NCCN Trends Survey asked survey participants about their practices regarding the testing of patients with NSCLC for EGFR mutations at the time of presentation with locoregional, distant recurrence, or stage IV metastatic disease. As expected, respondents more often test for these gene mutations when patients present with later stage disease as compared to earlier stage disease. Specifically, of the 533 respondents, 65% indicated that their patients were “sometimes” or “often” tested for EGFR mutations when patients present with Stage IV disease, compared to 44% who test when patients present with locoregional disease. This lower-testing rate for earlier stage disease can be explained given that about half of respondents (46%) test for EGFR mutations only when they are considering treatment with anti-EGFR therapy, which is typically used in advanced disease.
These survey questions were asked after initial results of the IPASS study were published in The New England Journal of Medicine,ii but before the final results from this study were publicized at the 2010 ESMO meeting. In a future survey, NCCN will reassess respondent preferences for the determination of EGFR mutation status in light of this new data.
iYang C, Fukuoka M, Mok TS, et al. Final overall survival (OS) results from a phase III, randomised, open-label, first-line study of gefitinib (G) v carboplatin/paclitaxel (C/P) in clinically selected patients with advanced non-small cell lung cancer (NSCLC) in Asia (IPASS). ESMO 2010; Abstract LBA2.
iiMaemondo M, Inoue A, Kobayashi K, et al. Gefitinib or chemotherapy for non–small-cell lung cancer with mutated EGFR. N Engl J Med. 2010; 362:2380-2388.