Discrepancies and lack of guideline adherence in EGFR+ NSCLC treatment

A recent study revealed disparities in treatment sequencing of epidermal growth factor receptor (EGFR)+ non-small-cell lung cancer (NSCLC); guideline recommendations are not being followed in some patients who have been recently diagnosed with this condition [1].

Project PRIORITY was a 2019/2020 joint study of the EGFR Resisters and the Lungevity Foundation, which aimed to capture real-world data about which treatments were reaching which patients. Ms Ivy Elkins (EGFR Resisters, USA) presented the findings of an online survey that asked patients to self-report treatment protocols employed in their care pathway – the number and names of agents as well as duration of treatment on each. A total of 425 patients and caregivers completed a baseline survey, and 127 of these respondents also completed a 6-month follow-up assessment. Approximately half of the respondents had been recently diagnosed.

In 2019, most patients in the US newly diagnosed with EGFR+ NSCLC were given the tyrosine kinase inhibitor (TKI) osimertinib, which was FDA approved as first-line treatment in 2018. Yet, some were not, suggesting that treatment was not always in accordance with guidelines. Outside of the US, most patients received earlier generation TKIs, i.e. erlotinib, gefitinib, or afatinib, as first-line therapy, suggesting an access issue. Many patients who had been given erlotinib or afatinib moved on to osimertinib as second-line therapy.

Project PRIORITY also asked patients about side effects experienced with their treatment. Although most TKIs have similar side effects, they seem to be less severe with osimertinib; Ms Elkins argued that this example demonstrates the importance of following guidelines for patient care – everyone who is eligible for osimertinib should have access to it, as it will impact the quality of life.

Ms Elkins concluded that this analysis highlighted that guideline-recommended pathways for EGFR+ NSCLC are not always being implemented. Because the newer generation TKIs seem to provide longer time to disease progression and also seem to be better tolerated than the older generation TKIs, they should be implemented as first-line therapy in eligible patients.

1. Elkins I. Treatment patterns in patients with EGFR-positive lung cancer: A real-world patient report. MA 05.05, WCLC 2021, 8–14 September.

 

Copyright ©2021 Medicom Medical Publishers



Posted on 21 September, 202129 February, 2024