Factors associated with gene aberration test status and treatment decision in patients with unresectable Stage IIIB/IV nonsquamous non-small cell lung cancer: A multicenter survey in China (CTONG 1506).

OBJECTIVES: This study investigated factors associated with (i) the likelihood of receiving a gene aberration test and (ii) the choice of treatment between chemotherapy and targeted therapy in patients with non-small cell lung cancer (NSCLC) in China. MATERIALS AND METHODS: This cross-sectional study analyzed data previously extracted from the medical charts of patients with unresectable Stage IIIB/IV nonsquamous NSCLC discharged from one of 12 tertiary hospitals in China between August 2015 and March 2016. Logistic regressions were applied to investigate factors associated with receiving a gene aberration test and the treatment decision. RESULTS: Data from 932 patients were analyzed. Patients were less likely to have a gene aberration test if they had a histologic subtype other than adenocarcinoma or a hospital waiting time for test results of >5 days. Patients were more likely to receive tyrosine kinase inhibitor (TKI) treatment than chemotherapy if they had a positive result for epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase gene aberration testing. EGFR positive patients were more likely to receive TKI treatment than chemotherapy if they did not have insurance for TKI or pemetrexed treatment, and more likely to receive chemotherapy than TKI treatment if they had a waiting time for test results of >5 days. EGFR wild-type/unknown patients receiving chemotherapy were more likely to receive pemetrexed if they attended a hospital in a developed area or had insurance for pemetrexed. CONCLUSION: In this real-world setting in China, the choice of first-line treatment for advanced NSCLC was appropriately guided by gene aberration testing for most patients. However, gene aberration testing and the treatment decision were influenced by practical factors such as hospital location, the waiting time for test results, and insurance coverage, which should be addressed to ensure optimal patient care.

Strategies to Improve Outcomes of Patients with EGRF-Mutant Non-Small Cell Lung Cancer: Review of the Literature.

Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI) monotherapy has been regarded as the standard first-line treatment of advanced non-small cell lung cancer (NSCLC) in patients with sensitive epidermal growth factor receptor gene (EGFR) mutations. Acquired resistance is inevitable, however, which presents a challenge in the management of patients with such mutations. Here, we summarize the clinical evidence on treatment strategies for both EGFR TKI-naive and acquired EGFR TKI-resistant NSCLC. We reviewed the published literature and abstracts of oral and poster presentations from international conferences addressing treatment strategies that are in use or in clinical development to improve the survival of patients who are EGFR TKI naive and EGFR TKI resistant. Various strategies have been explored to manage EGFR TKI resistance with the aim of prolonging the survival of patients with EGFR-mutant NSCLC. Combination strategies in the first-line treatment have been studied most to improve the benefit from EGFR TKI monotherapy and delay the occurrence of resistance. After failure of EGFR TKI monotherapy, continuation of EGFR TKI therapy combined with chemotherapy, immunotherapy, or targeted agents has been used to overcome the development of resistance. In addition, novel compounds designed to act on specific targets associated with EGFR TKI resistance have been in continued clinical development. Treatment regimens that are superior to EGFR TKI monotherapy in the first-line or to overcome acquired EGFR TKI resistance in patients with NSCLC and EGFR mutations still need to be developed. Results of ongoing studies will provide more insight into effective treatment strategies for patients with EGFR mutations.