In July 2010, NICE published a technology appraisal relating to the use of a Tyrosine Kinase Inhibitor (TKI) as first line treatment for patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) in whom an epidermal growth factor receptor (EGFR) mutation was found. Subsequently, the North of England Cancer Network implemented region wide testing for EGFR mutations in all patients with a pathological confirmation of NSCLC. A retrospective audit was undertaken to assess the quality of EGFR mutation testing, and to obtain data regarding those patients who had tested positive in order to improve local policy.Methods
Lung cancer MDT lead clinicians from every NHS trust in the region were contacted and asked to provide information about every patient with a confirmed diagnosis of NSCLC for whom specimens had been sent for EFGR mutation testing between October 2010 and February 2011.Results
The 9 trusts identified 314 patients in whom specimens had been sent for EGFR mutation testing; 161 (51%) males; average age 69 years (34–91); 60% were WHO performance status 0–1; 95% were current or ex-smokers; 47% (149) had stage 4 disease. 60 (19%) were female with adenocarcinoma. In 22 (7%) patients an EGFR mutation was found, 16 (73%) were female, 17 (77%) were current or ex smokers, 73% had stage 4 disease. 13 were female with adenocarcinoma, therefore prevalence in this group was 22% (cf 7% for whole local population). 14 (64% of EGFR mutation positive patients, and 4% of all patients tested) were treated with a TKI as first line, (23% had best supportive care, 13% surgery). EGFR mutation testing failed in 29 (9%) patients. The total cost of testing for this period is over £47 000.Conclusions
Local prevalence of EGFR mutations in all patients with NSCLC is 7%, but 22% for female patients with a diagnosis of adenocarcinoma. Prior to this audit, specimens were sent for testing by the pathologist on confirmation of a diagnosis of NSCLC. Local policy has changed as a result of this audit. Specimens are now sent for testing after discussion at the MDM, at the point of referral to Oncology.