Abstract
Testing for mutation of the EGFR (epidermal growth factor receptor) gene is a standard of care for patients with advanced nonsquamous non-small-cell lung cancer (nsclc). To improve timely access to EGFR results, a few centres implemented reflex testing, defined as a request for EGFR testing by the pathologist at the time of a nonsquamous nsclc diagnosis. We evaluated the impact of reflex testing on EGFR testing rates. A retrospective observational review of the Web-based AstraZeneca Canada EGFR Database from 1 April 2010 to 31 March 2014 found centres within Ontario that had requested EGFR testing through the database and that had implemented reflex testing (with at least 2 years' worth of data, including the pre- and post-implementation period). The 7 included centres had requested EGFR tests for 2214 patients. The proportion of pathologists requesting EGFR tests increased after implementation of reflex testing (53% vs. 4%); conversely, the proportion of medical oncologists requesting tests decreased (46% vs. 95%, p < 0.001). After implementation of reflex testing, the mean number of patients having EGFR testing per centre per month increased significantly [12.6 vs. 4.9 (range: 4.5-14.9), p < 0.001]. Before reflex testing, EGFR testing rates showed a significant monthly increase over time (1.37 more tests per month; 95% confidence interval: 1.19 to 1.55 tests; p < 0.001). That trend could not account for the observed increase with reflex testing, because an immediate increase in EGFR test requests was observed with the introduction of reflex testing (p = 0.003), and the overall trend was sustained throughout the post-reflex testing period (p < 0.001). Reflex EGFR testing for patients with nonsquamous nsclc was successfully implemented at multiple centres and was associated with an increase in EGFR testing.
Highlights
Several biomarkers have emerged as prognostic and predictive in advanced nonsquamous non-small-cell lung cancer
That trend could not account for the observed increase with reflex testing, because an immediate increase in EGFR test requests was observed with the introduction of reflex testing (p = 0.003), and the overall trend was sustained throughout the post–reflex testing period (p < 0.001)
Nsclc is an egfr tki; for patients with advanced EGFR-negative nonsquamous nsclc, chemotherapy or other targeted therapies are chosen[5,6,7]. In line with this personalized approach, the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology published consensus guidelines recommending that EGFR mutation testing be performed at time of diagnosis of nonsquamous nsclc for patients with advanced-stage disease who are suitable for therapy, with the results guiding treatment decisions[8,9]
Summary
Several biomarkers have emerged as prognostic and predictive in advanced nonsquamous non-small-cell lung cancer (nsclc). Based on consistent data showing that, compared with standard chemotherapy, egfr tkis improve clinical outcomes for patients with tumours harbouring EGFR activating mutations, the recommended systemic therapy for advanced nonsquamous nsclc takes a personalized approach: Recommended first-line treatment for patients with advanced EGFR-mutated nonsquamous nsclc is an egfr tki (erlotinib, gefitinib, or afatinib); for patients with advanced EGFR-negative nonsquamous nsclc, chemotherapy or other targeted therapies are chosen[5,6,7] In line with this personalized approach, the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology (cap/iaslc/amp) published consensus guidelines recommending that EGFR mutation testing be performed at time of diagnosis of nonsquamous nsclc for patients with advanced-stage disease who are suitable for therapy, with the results guiding treatment decisions[8,9]. We evaluated the impact of reflex testing on EGFR testing rates
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