Real‑world evaluation of molecular testing and treatment patterns for EGFR mutations in non‑small cell lung cancer in Latin America

Martin,Claudio; Cuello,Mauricio; Barajas,Olga; Recondo,Gonzalo; Aruachan,Sandra; Perroud,Herman; Sena,Susana; Bonilla,Carlos; Orlandi,Francisco; Berutti,Susana; Cocco,Virginia Garcia; Gomez,Alvaro; Korbenfeld,Ernesto; Zapata,Maycos; Cundom,Juan; Orellana,Eric; Goncalves,Susana; Reinhold,Florencia

doi:10.3892/mco.2021.2439

Real‑world evaluation of molecular testing and treatment patterns for EGFR mutations in non‑small cell lung cancer in Latin America

Authors:
- Claudio Martin
- Mauricio Cuello
- Olga Barajas
- Gonzalo Recondo
- Sandra Aruachan
- Herman Perroud
- Susana Sena
- Carlos Bonilla
- Francisco Orlandi
- Susana Berutti
- Virginia Garcia Cocco
- Alvaro Gomez
- Ernesto Korbenfeld
- Maycos Zapata
- Juan Cundom
- Eric Orellana
- Susana Goncalves
- Florencia Reinhold
View Affiliations

Affiliations: Department of Clinical Oncology, Institute Alexander Fleming, Buenos Aires C1426ANZ, Argentina, Department of Oncology, Hospital of Clinics, Montevideo 11600, Uruguay, Department of Medical Oncology, Arturo Lopez Perez Foundation, Santiago 7500000, Chile, Department of Thoracic Oncology, Medical education and Clinical Research Centre, University Institute (CEMIC), Buenos Aires C1431FWO, Argentina, Department of Clinical Oncology, High Technology Medical Institute Oncomedica, Monteria 23001, Colombia, Department of Clinical Oncology, Women's Health Centre, Rosario 2000, Argentina, Department of Clinical Oncology; German Hospital, Buenos Aires PC C1118AAT, Argentina, Clinical Oncology Unit, National Cancer Institute of Colombia, Bogotá 110411, Colombia, Department of Clinical Oncology, Orlandi Oncology, Providencia 7500713, Chile, Department of Clinical Oncology, Italian Hospital of La Plata, La Plata B1900AXI, Argentina, Department of Clinical Oncology, Italian Hospital, Cordoba 5000, Argentina, Department of Medical Oncology, Hemato‑oncologos SA, Cali 760042, Colombia, Department of Medical Oncology, British Hospital of Buenos Aires, Buenos Aires C1280AEB, Argentina, Department of Medical Oncology, Cancer Institute Las Americas, Antioquia 050025, Colombia, Department of Medical Oncology, Lanari Institute, University of Buenos Aires, Buenos Aires C1427ARN, Argentina, Department of Clinical Oncology, Clinic Santa Maria, Santiago 7500000, Chile, AstraZeneca Medical Department, Buenos Aires CP1437, Argentina
Published online on: November 12, 2021 https://doi.org/10.3892/mco.2021.2439
Article Number: 6
Copyright: © Martin et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Lung cancer is a leading cause of cancer‑related deaths in Latin America, with non‑small cell lung cancer (NSCLC) being the most prevalent. The current study aimed to report real‑world data on epidermal growth factor receptor (EGFR) mutational testing and treatment regimens at diagnosis and progression in patients with metastatic NSCLC across four Latin American countries (Argentina, Chile, Colombia and Uruguay). A retrospective, multicenter, observational study was conducted in patients with NSCLC using medical records from participating countries. The study population was categorized into two cohorts: Cohort 1 comprised of newly diagnosed, treatment‑naïve patients with stage IV NSCLC; and cohort 2 comprised of stage IV NSCLC EGFR mutation (EGFRm)‑positive patients who had progressed after first‑ or second‑generation EGFR‑tyrosine kinase inhibitor (TKI) treatment. Measures included demographic variables, health characteristics, treatment regimen, molecular testing rate and turnaround time at diagnosis and at progression for cohorts 1 and 2, respectively. Descriptive statistics were used to summarize all study measures. Of the 462 patients enrolled, 431 were newly diagnosed or treatment naïve with metastatic NSCLC. In cohort 1, the majority of patients with private health insurance (57.31%) underwent molecular diagnosis while only 41.3% of patients within the public sector had access to testing. The average molecular testing rate in cohort 1 varied across countries, with Argentina having the highest testing rate (79%) and Uruguay the lowest (27.63%). EGFRm was observed in 22% of patients. Cohort 2 comprised 31 patients who had progressed after first‑ or second‑generation EGFR‑TKI treatment and of these, only 22 (70.97%) underwent testing after progression. Access to molecular testing is still a challenge impacting the choice of first‑line treatment in Latin American patients with NSCLC.

View Figures

View References

1	Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J and Jemal A: Global cancer statistics, 2012. CA Cancer J Clin. 65:87–108. 2015.PubMed/NCBI View Article : Google Scholar
2	Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA and Jemal A: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 68:394–424. 2018.PubMed/NCBI View Article : Google Scholar
3	Smeltzer MP, Wynes MW, Lantuejoul S, Soo R, Ramalingam SS, Varella-Garcia M, Meadows Taylor M, Richeimer K, Wood K, Howell KE, et al: The international association for the study of lung cancer global survey on molecular testing in lung cancer. J Thorac Oncol. 15:1434–1448. 2020.PubMed/NCBI View Article : Google Scholar
4	Chen Z, Fillmore CM, Hammerman PS, Kim CF and Wong KK: Non-small-cell lung cancers: A heterogeneous set of diseases. Nat Rev Cancer. 14:535–546. 2014.PubMed/NCBI View Article : Google Scholar
5	American Cancer Society: Lung cancer statistics: American Cancer Society available lung cancer statistics: Available at: https://www.cancer.org/cancer/lung-cancer/about/what-is.html#:~:text=About%2080%25%20to%2085%25%20of,(outlook)%20are%20often%20similar.
6	Molina JR, Yang P, Cassivi SD, Schild SE and Adjei AA: Non-small cell lung cancer: Epidemiology, risk factors, treatment, and survivorship. Mayo Clin Proc. 83:584–594. 2008.PubMed/NCBI View Article : Google Scholar
7	Crinò L, Weder W, van Meerbeeck J and Felip E: ESMO Guidelines Working Group. Early stage and locally advanced (non-metastatic) non-small-cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 21 (Suppl 5):v103–v115. 2010.PubMed/NCBI View Article : Google Scholar
8	Economopoulou P and Mountzios G: The emerging treatment landscape of advanced non-small cell lung cancer. Ann Transl Med. 6(138)2018.PubMed/NCBI View Article : Google Scholar
9	Ettinger DS, Wood DE, Aisner DL, Akerley W, Bauman J, Chirieac LR, D'Amico TA, DeCamp MM, Dilling TJ, Dobelbower M, et al: Non-small cell lung cancer, version 5.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 15:504–535. 2017.PubMed/NCBI View Article : Google Scholar
10	National Lung Screening Trial Research Team. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM and Sicks JD: Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 365:395–409. 2011.PubMed/NCBI View Article : Google Scholar
11	Planchard D, Popat S, Kerr K, Novello S, Smit EF, Faivre-Finn C, Mok TS, Reck M, Van Schil PE, Hellmann MD, et al: Metastatic non-small cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 29 (Suppl 4):iv192–iv237. 2018.PubMed/NCBI View Article : Google Scholar
12	Raez LE, Nogueira A, Santos ES, dos Santos RS, Franceschini J, Ron DA, Block M, Yamaguchi N and Rolfo C: Challenges in lung cancer screening in Latin America. J Glob Oncol. 4:1–10. 2018.PubMed/NCBI View Article : Google Scholar
13	Raez LE, Cardona AF, Santos ES, Catoe H, Rolfo C, Lopes G, Barrios C, Mas LA, Vallejos C, Zatarain-Barrón ZL, et al: The burden of lung cancer in Latin-America and challenges in the access to genomic profiling, immunotherapy and targeted treatments. Lung Cancer. 119:7–13. 2018.PubMed/NCBI View Article : Google Scholar
14	Hirsch FR, Zaric B, Rabea A, Thongprasert S, Lertprasertsuke N, Dalurzo ML and Varella-Garcia M: Biomarker testing for personalized therapy in lung cancer in low- and middle-income countries. Am Soc Clin Oncol Educ Book. 37:403–408. 2017.PubMed/NCBI View Article : Google Scholar
15	Kris MG, Johnson BE, Berry LD, Kwiatkowski DJ, Iafrate AJ, Wistuba II, Varella-Garcia M, Franklin WA, Aronson SL, Su PF, et al: Using multiplexed assays of oncogenic drivers in lung cancers to select targeted drugs. JAMA. 311(1998)2014.PubMed/NCBI View Article : Google Scholar
16	Arrieta O, Cardona AF, Martín C, Más-López L, Corrales-Rodríguez L, Bramuglia G, Castillo-Fernandez O, Meyerson M, Amieva-Rivera E, Campos-Parra AD, et al: Updated frequency of EGFR and KRAS mutations in nonsmall-cell lung cancer in Latin America: The Latin-American consortium for the investigation of lung cancer (CLICaP). J Thorac Oncol. 10:838–843. 2015.PubMed/NCBI View Article : Google Scholar
17	Lindeman NI, Cagle PT, Beasley MB, Chitale DA, Dacic S, Giaccone G, Jenkins RB, Kwiatkowski DJ, Saldivar J, Squire J, et al: Molecular testing guideline for selection of lung cancer patients for EGFR and ALK tyrosine kinase inhibitors: Guideline from the College of American pathologists, international association for the study of lung cancer, and association for molecular pathology. J Thorac Oncol. 8:823–859. 2013.PubMed/NCBI View Article : Google Scholar
18	Chiang AC, Fernandes AW, Pavilack M, Chiang AC, Wu JW, Laliberté F, Duh MS, Chehab N and Subramanian J: EGFR mutation testing and treatment decisions in patients progressing on first- or second-generation epidermal growth factor receptor tyrosine kinase inhibitors. BMC Cancer. 20(356)2020.PubMed/NCBI View Article : Google Scholar
19	Oxnard GR, Arcila ME, Sima CS, Riely GJ, Chmielecki J, Kris MG, Pao W, Ladanyi M and Miller VA: Acquired resistance to EGFR tyrosine kinase inhibitors in EGFR-mutant lung cancer: Distinct natural history of patients with tumors harboring the T790M Mutation. Clin Cancer Res. 17:1616–1622. 2011.PubMed/NCBI View Article : Google Scholar
20	Yu HA, Arcila ME, Rekhtman N, Sima CS, Zakowski MF, Pao W, Kris MG, Miller VA, Ladanyi M and Riely GJ: Analysis of tumor specimens at the time of acquired resistance to EGFR-TKI therapy in 155 patients with EGFR-mutant lung cancers. Clin Cancer Res. 19:2240–2247. 2013.PubMed/NCBI View Article : Google Scholar
21	Soria-Comes T, Palomar-Abril V, Ureste MM, Guerola MT and Maiques ICM: Real-world data of the correlation between EGFR determination by liquid biopsy in non-squamous non-small cell lung cancer (NSCLC) and the EGFR profile in tumor biopsy. Pathol Oncol Res. 26:845–851. 2020.PubMed/NCBI View Article : Google Scholar
22	Su PL, Yang SC, Chen YL, Wu YL, Lin CY, Chang WY, Tseng YL, Lai WW, Ho CL, Lin CC and Su WC: Real-world outcomes of NSCLC patients receiving tissue or circulating tumor DNA-guided osimertinib treatment. Cancer Med. 8:5939–5947. 2019.PubMed/NCBI View Article : Google Scholar
23	Mhanna L, Guibert N, Milia J and Mazieres J: When to consider immune checkpoint inhibitors in oncogene-driven non-small cell lung cancer? Curr Treat Options Oncol. 20(60)2019.PubMed/NCBI View Article : Google Scholar