Abstract
This study determined the frequency and factors associated with EGFR testing rates and erlotinib treatment as well as associated survival outcomes in patients with non small cell lung cancer in Kentucky. Data from the Kentucky Cancer Registry (KCR) linked with health claims from Medicaid, Medicare and private insurance groups were evaluated. EGFR testing and erlotinib prescribing were identified using ICD-9 procedure codes and national drug codes in claims, respectively. Logistic regression analysis was performed to determine factors associated with EGFR testing and erlotinib prescribing. Cox-regression analysis was performed to determine factors associated with survival. EGFR mutation testing rates rose from 0.1% to 10.6% over the evaluated period while erlotinib use ranged from 3.4% to 5.4%. Factors associated with no EGFR testing were older age, male gender, enrollment in Medicaid or Medicare, smoking, and geographic region. Factors associated with not receiving erlotinib included older age, male gender, enrollment in Medicare or Medicaid, and living in moderate to high poverty. Survival analysis demonstrated EGFR testing or erlotinib use was associated with a higher likelihood of survival. EGFR testing and erlotinib prescribing were slow to be implemented in our predominantly rural state. While population-level factors likely contributed, patient factors, including geographic location (areas with high poverty rates and rural regions) and insurance type, were associated with lack of use, highlighting rural disparities in the implementation of cancer precision medicine.
Highlights
Lung cancer is the leading cause of cancer death in the United State [1], and Kentucky leads the nation in both the rate of new cases and deaths due to cancer, with the Appalachian region carrying the highest cancer burden [2,3,4]
From 2007 to 2011 the percentage of patients presenting with locally advanced or advanced stage disease that were tested for EGFR mutations increased from 0.1% to 10.6% (Table 2), while erlotinib use ranged from 3.4% to 5.4% with no trend over time
Erlotinib was approved as a second-line therapy in 2004 for metastatic non-small cell lung cancer (NSCLC) regardless of EGFR status, and its rate of use was minimal in the years examined [8]
Summary
Lung cancer is the leading cause of cancer death in the United State [1], and Kentucky leads the nation in both the rate of new cases and deaths due to cancer, with the Appalachian region carrying the highest cancer burden [2,3,4]. The high incidence and death rates in Kentucky demonstrate a clear need for more effective interventions in lung cancer patients. Clinical studies associating EGFR mutations with better response to tyrosine kinase inhibitors were reported in 2004 [5,6,7]. Uptake of precision medicine in NSCLC in Kentucky addition, there are contractual agreements between the University of Kentucky and the Kentucky Cancer Registry precluding data sharing. McDowell, Epidemiologist, Kentucky Cancer Registry 2365 Harrodsburg Rd, Suite A230 Lexington, KY 40504 859-218-2228
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