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Testing as an opportunity

Mutations of NSCLC

Pathologie des NSCLC

Adapted according to Tsao AS, et al 20151

More than half of all non-small lung cancers (NSCLC) can be characterised more precisely at the molecular pathology level and divided into numerous subentities.2

Molecular diagnostic testing for therapy relevant mutations enables the use of targeted therapies. In non-small cell lung cancer, analysis of EGFR mutations provides the key to treatment with EGFR tyrosine kinase inhibitors.

In a meta-analysis with 456 studies and a total of 115,815 NSCLC patients, EGFR mutations occurred with a prevalence of 32.3%.3 This varied only slightly in the different stages of NSCLC.3 However, if the prevalence is examined according to various regions, clear regional differences become apparent.3

Prevalence

Prevalence of the EGFR mutation

Prevalence in Europe: 14.1 %.3 The prevalence of EGFR mutations varies only slightly between different NSCLC stages.3

Pooled prevalence in different NSCLC stages

Gepoolte Prävalenz in verschiedenen NSCLC-Stadien

Pooled prevalence in different regions

Gepoolte Prävalenz in verschiedenen Regionen

Testing in practice

  • REFLEX TESTING
  • ADAURA
  • FLAURA / FLAURA-2

The advantages of reflex testing

Standardised procedures can contribute to optimal EGFR testing4

ESMO recommended

Reflex molecular testing

Reflex Molecular Testing Icon

Molecular testing is automatically ordered by the pathologist for specific, agreed biomarkers as soon as an appropriate diagnosis is made (e. g. EGFR testing for non-squamous NSCLC)5

Reflex TESTING PATHWAY

Advantages

  • icon

    More patients tested5,6

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    Standardisation of testing

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    Shorter testing turnaround time4,5
    Shorter time to treatment initiation5,6

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    Efficient use of tissue5
    Increased laboratory efficiency

Disadvantages

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May cost more (dependent on no. of genes included in the reflex testing algorithm)5

Potential reflex testing pathways

reflex testing pathways
More information about Risk of recurrence

References:

  1. Tsao AS, et al. Scientific Advances in Lung Cancer 2015. J Thorac Oncol. 2016 May;11(5):613-638.
  2. Pao W, Girard N. New driver mutations in non-small-cell lung cancer. Lancet Oncol. 2011 Feb;12(2):175-80.
  3. Zhang YL, et al. The prevalence of EGFR mutation in patients with non-small cell lung cancer: a systematic review and meta-analysis. Oncotarget. 2016 Nov 29;7(48):78985-78993.
  4. Anand K, et al. Clinical Utility of Reflex Ordered Testing for Molecular Biomarkers in Lung Adenocarcinoma. Clin Lung Cancer. 2020; 21 (5): 437–442. doi: 10.1016/j cllc.2020.05.007.
  5. Aggarwal C, et al. Molecular testing in stage I–III non-small cell lung cancer: Approaches and challenges. Lung Cancer. 2021; 162: 42–53. doi: 10.1016/j.lungcan.2021.09.003.
  6. Gregg JP, et al. Yoneda KY. Molecular testing strategies in non-small cell lung cancer: optimizing the diagnostic journey. Transl Lung Cancer Res. 2019; 8 (3):286–301. doi:10.21037/tlcr.2019.04.14.
  7. Aisner DL, et al. Do More With Less: Tips and Techniques for Maximizing Small Biopsy and Cytology Specimens for Molecular and Ancillary Testing: The University of Colora do Experience. Arch Pathol Lab Med. 2016; 140 (11): 1206–1220. doi: 10.5858/arpa.2016-0156-RA.
  8. D'Angelo SP, et al. Reflex testing of resected stage I through III lung adenocarcinomas for EGFR and KRAS mutation: report on initial experience and clinical utility at single center. J Thorac Cardiovasc Surg. 2011; 141(2): 476-480. doi: 10.1016/j.jtcvs.2010.08.026.
  9. Gosney JR, et al. Pathologist-initiated reflex testing for biomarkers in non-small-cell lung cancer: expert consensus on the rationale and considerations for implementation. ESMO Open. 2023 Aug;8(4):101587. doi: 10.1016/j.esmoop.2023.101587.
  10. Remon J et al. Early and locally advanced non-small-cell lung cancer: an update of the ESMO Clinical Practice Guidelines focusing on diagnosis, staging, systemic and local therapy, Annals of Oncology 2021; 32(12): 1637-42
  11. Referenced with the approval of NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for NSCLC V.2.2024. ©National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Access on 02/21/2024. NCCN gives no guarantee of any kind with regard to their content or use and rejects any responsibility for their use in any way.

TAGRISSO®
Comp: Osimertinib; 40 mg and 80 mg film-coated tablets; List A. Ind: TAGRISSO is indicated as monotherapy for the adjuvant treatment after complete tumour resection in adult patients with non-squamous, non-small cell lung cancer (NSCLC) with EGFR (epidermal growth factor receptor) exon 19 deletions or exon 21 (L858R) substitution mutations, for the first-line treatment in adult patients with locally advanced or metastatic NSCLC with EGFR exon 19 deletions or exon 21 (L858R) substitution mutations, for the treatment of adult patients with locally advanced or metastatic NSCLC with EGFR‑T790M‑mutation who have progressed on or after EGFR TKI therapy, as well as in combination with pemetrexed and platinum‑based chemotherapy for the first-line treatment of adult patients with locally advanced or metastatic, non-squamous NSCLC whose tumours have EGFR exon 19 deletions or exon 21 (L858R) substitution mutations. Dos: 80 mg once daily in monotherapy as well as in combination with pemetrexed and 4 cycles platinum-based chemotherapy. CI: Hypersensitivity to the active substance or to any of the excipients. Concomitant use of St. John’s Wort. W&P: Interstitial lung disease. Erythema multiforme. QTc interval prolongation. LVEF and cardiomyopathy. Diarrhoea. Age and body weight. IA: Strong CYP3A inducers. CYP3A4 substrates and transporters. ADRs: Very common: diarrhoea, stomatitis, rash, dry skin, paronychia, pruritus, platelet count decreased, leukocytes decreased, lymphocytes decreased, neutrophils decreased, blood creatinine increased. Common: interstitial lung disease, epistaxis, palmar-plantar erythrodysaesthesia syndrome, alopecia, urticaria, blood creatine phosphokinase increased, QTc interval prolongation, cardiac failure, left ventricular ejection fraction decreased, erythema multiforme, skin hyperpigmentation. Uncommon, rare, very rare: see www.swissmedicinfo.ch. Date of revision of the text: December 2023.

Further information: www.swissmedicinfo.ch or AstraZeneca AG, Neuhofstrasse 34, 6340 Baar, Switzerland. www.astrazeneca.ch.

Professionals can request the mentioned references from AstraZeneca AG.