A survey of 562 oncologists in 10 countries found that nearly a quarter of people with advanced lung cancer in the U.S., Asia, and Europe did not receive epidermal growth factor receptor (EGFR) test results before they started treatment, according to research presented in April at the European Lung Cancer Conference.

Guidelines from the International Association for the Study of Lung Cancer recommend testing for EGFR mutation at the time of advanced non-small cell lung cancer diagnosis and using the results to guide treatment decisions. However, anecdotal evidence suggests that these recommendations are not always followed, according to the study authors. This prompted them to see how widely hospitals had implemented EGFR mutation testing in cases of advanced lung cancer.

"The arrival of a new group of targeted EGFR inhibitors for the treatment of lung cancer driven by mutations in the EGFR gene has brought with it a new requirement for diagnostic laboratories to implement genetic testing," said researcher James Spicer, a medical oncologist from King's College London at Guy's Hospital, London, in a prepared statement. "For many institutions this has represented a significant departure from traditional pathology, which had previously focused only on microscopic examinations of tumour tissue."

All patients who have non-small cell lung cancer of non-squamous histology and are able to be treated for advanced disease should have EGFR tests, but it’s taken some time for this technology to be widely offered. “Furthermore, the new clinical data underlying these developments has mandated a change in clinical practice, particularly the adoption of new treatment approaches in newly diagnosed patients, and these changes have been adopted with variable speed around the world," Spicer said.

Overall, survey respondents indicated that EGFR mutation testing was requested prior to first-line therapy in 81% of patients with stage IIIb/IV non-small cell lung cancer, and results were available before treatment started in 77% of cases. "Not only were some suitable patients not tested at all for tumour EGFR mutations, some patients did undergo testing, but the treatment decision about whether to give an EGFR inhibitor or chemotherapy as first line treatment was taken without reference to the result," said Spicer.

Survey participants cited lack of sufficient tissue, long testing turnaround times, and the poor performance status of the patient as reasons for foregoing the test or starting treatment without having EGFR test results.