P3.02b-049 EGFR-Mutated NSCLC: Clinical Practice Assessment and Gap Analysis: Topic: EGFR Clinical

Abstract

For patients with advanced NSCLC, mutations in the epidermal growth factor receptor (EGFR) gene predict sensitivity to EGFR tyrosine kinase inhibitors (TKIs). Consequently, EGFR TKIs in both the first and second line (for T790M +ve) are now considered the standard of care. This study’s objective was to assess current clinical practices of oncologists and pathologists in the management of EGFR-mutated NSCLC to identify knowledge, competency, and practice gaps and barriers to improving patient care. An educational needs assessment consisting of 25 questions was developed. The assessment design included case vignettes and knowledge- and case-based, questions based on evidence-based consensus guidelines. The assessment was made available online to healthcare providers without monetary compensation or charge. Confidentiality of survey respondents was maintained and responses were de-identified and aggregated prior to analyses. The assessment launched on February 26, 2016, and responses were collected through June 10, 2016. In total, 226 US physicians responded to the survey. Respondents were most likely to be oncologists. Practice setting was almost evenly divided between academic and community. Knowledge gaps: 40% of oncologists and 52% of pathologists were unable to correctly identify the IASLC guideline recommendations on molecular profiling while 45% of oncologists and 54% of pathologists could not identify the efficacy of approved first line EGFR TKIs. Confidence gaps: Less than 10% of oncologists and pathologists are very confident in their understanding of liquid biopsies. In addition, only 23% of oncologists were very confident in their ability to individualize first line treatment. Performance gaps: Between 43%-60% of oncologists and pathologists incorrectly indicated they would prescribe first line therapy for a patient with an activating EGFR mutation. Despite an available therapy for patients with an identified T790M mutation, 41%-72% oncologists and pathologists indicated they would not undertake a biopsy in a patient with EGFR-mutated NSCLC that had progressed on a first line EGFR TKI and only 12% of oncologists noted that they always test to determine the mechanism of resistance. One-third of oncologists indicated would not select the most appropriate treatment option for a patient whose disease progressed on first line EGFR TKI therapy and whose tumor did not contain a T790M mutation. This assessment of clinical practices provided insights into gaps in the knowledge, competency and practices regarding molecular testing and management of EGFR-mutated NSCLC. Focused educational efforts are urgently needed to inform the practicing physicians on recent advances in targeted therapy for advanced NSCLC.