P59.32 Physician Attitudes Toward Genetic Testing and Targeted Therapy for Advanced NSCLC Patients in China: A Nationwide Survey

Abstract

The purpose of this survey is to explore the situation of genetic testing and targeted therapy in advanced non-small cell lung cancer (NSCLC) patients in China. The survey was conducted in oncology, respiratory and thoracic surgery departments between May 2020 and September 2020 across 135 cities in China. The participating physicians had >5 years of clinical experience in NSCLC diagnosis and treatment. Among 450 participating physicians, 361(80.2%) and 89 (19.8%) were from the tertiary and non-tertiary hospitals, respectively. For newly diagnosed patients, epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) rearrangement, and ROS proto-oncogene 1 (ROS1) fusion testing were recommended by 83.4%, 72.9% and 68.3% of physicians, respectively. For patients who had not received any tyrosine kinase inhibitor (TKI) therapy, who had received one line, and who had received ≥2 lines of TKI therapy, the recommended percentage of genetic testing by physicians declined gradually, which were 81%, 56% and 45%, respectively. Similarly, with the increasing number of TKIs treatment lines, the genetic testing rate of patients decreased gradually, which were 77.9%, 59.5% and 46.7%. Patients refused genetic testing either because their incomprehension or it was costly. The accessibilities of genetic testing of EGFR, ALK and ROS1 in respective pathology departments were 81.9%, 75.5% and 65.6%, respectively. Among the newly diagnosed patients with EGFR mutation, 77% received TKI therapy during first-line treatment, of which 49% were treated with Gefitinib. Furthermore, among patients with ALK rearrangement, 71% received TKI therapy during first-line treatment, of which 64% were treated with Crizotinib. Among patients with ROS1 fusion, 65% received TKI therapy during first-line treatment, of which 88% patients were treated with Crizotinib. The recommended percentage of physicians, the percentage of patients’ genetic testing and the proportion of TKIs use were all higher numerically in tertiary hospitals. Although driver gene mutation is common in Asian NSCLC patients, some newly diagnosed Chinese patients failed to undergo timely testing and consequent targeted therapy, especially for ROS1 fusion. Compared to the tertiary hospitals, the physicians' awareness of genetic testing, accessibility of genetic testing of the hospital, and patients’ genetic testing rate were lower in non-tertiary hospitals. Patients with EGFR mutation or ALK rearrangement received more targeted therapy than those with ROS1 fusion. Thus, imparting education on ALK and ROS1 to physicians and patients is imperative to increase the recommended percentage of genetic testing and the proportion of targeted drug therapy.