Author of

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  P2.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 234)

  • Event: WCLC 2015
  • Type: Poster
  • Track: Biology, Pathology, and Molecular Testing
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)

  • 14510

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    P2.04-020 - Epidermal Growth Factor Receptor (EGFR) Testing among Veterans Diagnosed with Lung Cancer (ID 3098)

    09:30 - 09:30  |  Author(s): M. Kelley
    • Abstract
    • Slides

    Background:
    Molecular profiling has resulted in new, targeted therapies that may improve survival for non-small cell lung cancer patients (NSCLC). Erlotinib is used in stage-IV patients and requires testing patients’ tumors for EGFR mutations. In 2010, guidelines recommended screening for EGFR gene mutations in non-squamous, stage IV NSCLC patients. Current guidelines recommend testing for all patients diagnosed with adenocarcinoma. Data on population-level implementation of molecular tests are sparse, yet are crucial to evaluate differences in access and outcomes.
    
    Methods:
    Patient-level test orders and results from January 2011 until December 2013 were provided by reference laboratories that conduct molecular testing for VA medical centers (VAMCs). The VA Central Cancer Registry (VACCR) reported clinical characteristics of lung cancer patients diagnosed in 2011 and 2012. We analyzed rate of testing, prevalence of EGFR mutations, clinicians’ perspectives regarding testing, and characteristics that predicted likelihood to undergo testing.
    
    Results:
    Our previous data showed that in 2010, 15 VAMCs ordered 93 assays. Lab data from 2011 to 2013 identified 986 tests ordered by 70 VAMCs, of which 352 were newly diagnosed patients included in the VACCR for 2011/2012. Patient characteristics of those tested were: 95% male, age (M=67, range 23 to 93). VACCR data (95% male, age (M=68, range 28 to 97) showed that 2,889 (19.64%) of Veterans diagnosed in 2011/2012 were eligible for EGFR testing. Clinicians reported an expected low rate of EGFR mutations among the Veteran clinical phenotype (histology, smoking status, gender). Lab and VACCR data confirmed this. Activating EGFR mutations were detected in 5.6% of cases. The 2361G>A polymorphism, missense mutations expected to be clinically insignificant, and variants of unknown significance were detected in 16.7%, 2.3% and 0.8% of patients, respectively. 70.1% of patients were negative for EGFR mutations. 4.4% of tests were not processed for technical reasons.
    
    Conclusion:
    Veterans have a much lower rate clinically actionable EGFR mutations than the reported average of 15%. Among Veterans diagnosed with lung cancer, 52% are current smokers, 40% are former smokers, which may explain the low rate of EGFR mutations.
    
    

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