Thanks Turna Ray, this is such important information for those with NSCLC. Want to elevate the experts call for greater transparency in regards to EGFR status. Use of EGFR TKIs is only indicated for a few select variants in the first line setting (e.g., exon 19 deletion, L858R) as not all EGFR variants benefit from TKI treatment. Some dual-positives may have immunotherapy as the preferred choice for treatment when considering both PD-L1 and EGFR specific variant status. Without knowing the specific EGFR variant, it is hard to know how to interpret this data. It could be that the decreased survival in those treated with immunotherapy was secondary to a missed opportunity for EGFR TKI treatment for those with select EGFR variants. On the other hand, it could merely reflect a decreased survival benefit from immunotherapy for those without select EGFR variants where an EGFR TKI is not indicated. Without disclosure of the EGFR variants, it is impossible to tease these two potentials apart. Knowing how to address this concern in clinical practice depends on this clarity. More transparent disclosure of both the gene and variants when looking at outcomes data is urgently needed.
Managing editor of Precision Medicine Online; reporter at GenomeWeb contributing in-depth features
A real-world data analysis of patients who were found have PD-L1 expression- and EGFR mutation-positive tumors between late 2018 and 2023, showed that around 40 percent received front-line anti-PD-1/PD-L1 treatment instead of an EGFR inhibitor like the National Comprehensive Cancer Network® (NCCN®) recommends. Dual-positive patients who received first-line EGFR inhibitors lived longer than those who didn't. Broadly, these findings are in line with other studies that have shown over the years that patients aren't receiving appropriate biomarker-informed treatment. But experts reflecting on this latest data said they want more granular analysis of prescribing patterns based on year of treatment and patients' EGFR mutation type to better understand if more patients today are getting guideline-condordant care than they were back in 2018 and if clinical practice is headed in the right direction. https://lnkd.in/eBfMtGWR
Genetic Counselor, Genomic Policy and Value Researcher, Utilization Management, Medical Affairs, Managed Care and Market Access for Genetic Testing
5moThis data is not surprising, sadly. Roughly 50% of patients with mNSCLC are not receiving any EGFR testing (Roberts et al., 2023 JAMA Open and Dacosta Byfield et al., ASCO abstract 6633, Wiedower et al., NCCN poster 31), which is almost certainly a large contributor to the over-use of ICI and poor outcomes. Regarding the research brief, I imagine brevity and consensus regarding actionable EGFR variants (as laid out in NCCN and clinical trial evidence) led to the omission of EGFR variants, and having published on 1L NSCLC treatments in EGFR positive patients myself, it is often included in the peer-reviewed publications when such language is used in lay materials. I would be surprised if the authors indexed EGFR variants which do not have clinical trial evidence of TKI efficacy in first line setting. I would also be surprised if the specific EGFR variants had bearing on the result in the manner suggested, since the dual positives had better outcomes on TKI.....but we shall see if the work is published!