Audit of EGFR mutation testing in patients with proven Non-Small Cell Lung Cancer On behalf of the North of England Cancer Network Lung NSSG Dr Naomi Chamberlin, Dr Ann Ward

Aims  Overview of brief  Method  Contributing Trusts  Results  Discussion

Overview of brief  To gather data on all patients with a diagnosis of non-small cell lung cancer across the Network for whom specimens have been sent for EGFR mutation testing.  To audit the success of EGFR mutation testing  To assess demographics of patients in whom an EGFR mutation is found  Provide evidence for discussion about change in approach if required

Method  Within the Network, the lead clinician for each trust’s Lung Cancer MDT was contacted.  Each was asked to collect data for all patients with non-small cell lung cancer identified between October 2010 and February  All results were confidential  No patient identifiable data was included in the information shared.  A copy of the original audit proforma, and example spreadsheet were also sent to each lead clinician

Contributing Trusts  North Cumbria  Northumbria  Newcastle  Gateshead  Sunderland  South Tyneside  Durham and Darlington  North Tees

Contributing Trusts  North Cumbria (n=18)  Northumbria (n=42)  Newcastle (n=68)  Gateshead (n=22)  Sunderland (n=31)  South Tyneside (n=13)  Durham and Darlington (n=26)  North Tees (n=48)

Demographics – all patients  268 patients details included  Male: Female(%) 52:48  Age distribution 34-90, average age 68 years  95% current or ex-smokers  63% WHO PS 0-1  52% stage 4 disease

Age distribution

Smoking status

WHO Performance status

Stage – all patients

Pathology – all patients  43% Adenocarcinoma  31% Squamous cell  Histology: Cytology(%) 57:43

Pathology

1 st line treatment – all patients

EGFR data – all patients  EGFR mutation found in 18 patients (7%)  61% of patients who tested positive for EGFR mutation were treated with TKI  EGFR mutation testing failed in 29 patients (11%)  Of these specimens: 27% histology, 73% cytology

Trust numbers: TrustN =EGFR +veTest Failure Durham and Darlington2632 Gasteshead2220 Newcastle68417 North Cumbria1805 North Tees4843 Northumbria4240 South Tyneside1300 Sunderland3112

EGFR mutation found

EGFR mutation +ve population

EGFR test failures

(73% cytology, 27% histology)(No patients received TKI)

Discussion  1) Small proportion of positive tests (7%)  Each test costs approximately £150  Total cost to Network > £  2) Proportion of failed tests variable between trusts (0-25%)  Are different test centres being used?  Does this equate to different methodology?  How can we improve on failure rate?  Are there different policies re: which samples to send, (i.e. a selection bias)  Much higher proportion of failed specimens cytology

Continued…  3) 10/18 EGFR mutation +ve patients were female with adenocarcinoma  43 of all patients were female with adenocarcinoma  Overall chance of positive test was 7%  Overall chance of female with adenocarcinoma having EGFR mutation is 10/43, i.e. 23%  Should a diagnosis of adenocarcinoma in female patients prompt sending a repeat test if initial test failed?

Continued…  4) Under 2/3 of EGFR mutation positive patients receiving TKI therapy  39% of EGFR positive patients had either surgery or best supportive care  When will a positive case influence management?  Should WHO PS and staging guide which samples are sent rather than blanket policy?  Should trigger to send for testing be at the point of referral to the Oncologist? Would this delay treatment?

And finally…  A huge thanks to all of those who collected the data from the contributing trusts.  It is hoped that this data will be submitted to the BTS Winter Meeting on behalf of the North of England Cancer Network Lung NSSG.

Thank you