Awareness about EGFR testing and use of TKIs in advanced lung cancer: A questionnaire-based survey of medical oncologists from India.

Abstract

e19116 Background: EGFR is an important driver mutation in lung cancer. The pattern of usage of EGFR mutation testing is not well defined in the Indian population. Methods: A total of 70 medical oncologists from India were interviewed to identify current practices in the management of advanced lung cancer. They were in clinical practice for 2 to 35 (median 9) years. Their affiliation included medical college (21), regional cancer center (6), corporate hospitals (29) and private practice (14). Their collective experience in conducting international clinical trials in lung cancer was significant (range 0 to 35 trials). Results: The number of new patients with lung cancer seen by them in a month was a median of 8 (range 1 to 20). EGFR testing on the lung cancer tissue was recommended in a median of 60 % (range 10 to 100 %) of paients and was actually carried out in a median of 30 % (range 0 to 90 %). Tissue samples were inadequate for EGFR testing in 30 % of cases (range 2 to 95 %). Method of EGFR testing used included IHC by 06, molecular by 52 and both by 12 of the oncologists. The time to obtain a report was 10 days (range 5 to 21 days). EGFR testing showed mutation/ overexpression in approximately 25 % of cases (range 0 to 70 %. In a large national tertiary cancer center with inhouse laboratory that did testing by PCR and sequencing, EGFR mutations were seen in 30 % of 481 samples. The EGFR mutations considered clinically important included del 19 by 56, L858R by 41 and T790M by 31 of the responding oncologists. The first line therapy used in EGFR mutation positive Lung cancer patients was platinum doublet chemotherapy by 7, gefitinib by 55 and erlotinib by 8 oncologists. The side effects of TKIs considered important were diarrhea by 64, mucositis by 47, rash by all 70, paronychea by 50, nausea vomiting by 52, fatigue by 51 and myelosuppression by 6. The common methods of managing these side effects included dose reduction by 22, drug interruption by 50, symptomatic treatment by 49 and counseling by 22. Conclusions: The awareness about EGFR mutation and use of TKIs among medical oncologist is increasing in India. However availability of sufficient tissue for molecular testing remains a problem.