Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Queensland state-wide patterns and access to EGFR mutation testing for metastatic, non-squamous non-small cell lung cancer (non-SQ NSCLC) from 2014-2021 (#277)

Navin Niranjan 1 2 , Zane Yang 1 , Robert Mason 1 2 , Tracey Guan 3 , Bryan Chan 4 5 6 7 , Jasotha Sanmugarajah 1 2
  1. Gold Coast University Hospital, Southport, Queensland, Australia
  2. Griffith University School of Medicine and Dentistry, Southport, Queensland , Australia
  3. Cancer Alliance Queensland, Woolloongabba, Queensland, Australia
  4. Gold Coast University Hospital, Southport, QUEENSLAND, Australia
  5. Griffith School of Medicine and Dentistry, Birtinya , Queensland , Australia
  6. Centre for Bioinnovation, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
  7. Adem Crosby Cancer Centre, Sunshine Coast Hospital and Health Service,, Birtinya , Queensland, Australia

Background

EGFR is the most common actionable genomic alteration in NSCLC.  In late 2013, EGFR mutation testing was publicly funded for NSCLC. However, prompt EGFR results are not universally available, affecting equitable access to timely treatment.

Aims

To examine EGFR testing rates over time and factors impacting results and timeliness of outcomes.  

Methods

This was a retrospective audit of 3827 patients between 2014-2021 identified via the Queensland Oncology Repository.  Primary outcomes were EGFR mutation testing rates and time from first sampling to result, stratified by year of diagnosis and rurality.

Results

Of patients identified 458 were excluded (329 due to publicly unavailable EGFR results and 129 due to incorrect listing as non-SQ NSCLC).  Of the 3369 cases included, 2871 (85.2%) had EGFR testing.  An EGFR mutation was detected in 12.6% of cases.  For cases without conclusive EGFR results, reasons included: 179 transitioned to best supportive care, 208 with insufficient tissue, and 155 for unclear reasons.

Mean time from sampling to EGFR result improved from 29.9 to 21.5 days between 2014-2021, with no significant difference based on rurality.  The rate of cases with no EGFR results improved from 23.7% in 2014-2015 to 11.0% in 2020-2021.

Cases with inconclusive EGFR results were more prevalent rurally. Of patients from outer regional/remote areas 21.1% had an inconclusive result, compared to 15.5% from major cities/inner regional sites. This was a significant relative increase of 36.2% (95% CI: 10.1%-68.6%, χ2=7.7483, p=0.005). Cases with inconclusive EGFR results in outer regional/remote sites declined from 30.1% in 2014-2015 to 15.3% in 2020-2021. 

Conclusions

EGFR mutation testing and mean time to results have improved from 2014 to 2021. Although time to result was not affected by location, significantly more rural patients lacked conclusive EGFR results, highlighting the need for further process and quality improvement to ensure equitable care state-wide. 

  1. Credit Line: 2024 American Society of Clinical Oncology, Inc. Reused with permission. This abstract was accepted and previously presented at the [2024 ASCO Annual Meeting]. All rights reserved.