AUTHOR=Pasello Giulia , Lorenzi Martina , Pretelli Giulia , Comacchio Giovanni Maria , Pezzuto Federica , Schiavon Marco , Buja Alessandra , Frega Stefano , Bonanno Laura , Guarneri Valentina , Calabrese Fiorella , Rea Federico 

TITLE=Diagnostic-Therapeutic Pathway and Outcomes of Early Stage NSCLC: a Focus on EGFR Testing in the Real-World

JOURNAL=Frontiers in Oncology

VOLUME=12

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.909064

DOI=10.3389/fonc.2022.909064

ISSN=2234-943X

ABSTRACT=<sec><title>Background</title><p>Osimertinib is considered the standard-of-care for previously-untreated <italic>EGFR</italic> mutant advanced non-small cell lung cancer (NSCLC). Oncogene driver screening in early NSCLC is not standard practice. A real-world study has been designed in order to investigate the optimal testing frequency and timing for <italic>EGFR</italic> mutations in early NSCLC in clinical practice.</p></sec><sec><title>Patients and Methods</title><p>The present observational, retrospective study evaluated the real-world diagnostic-therapeutic pathway and clinical outcomes of 225 patients with stage I-III NSCLC, with particular reference to the <italic>EGFR</italic>-mutant subgroup.</p></sec><sec><title>Results</title><p>Prior to surgery, 101 patients had undergone a diagnostic biopsy; <italic>EGFR</italic> mutational analysis was available in 56 (55%) patients and 12 patients (21%) had a cancer harboring an <italic>EGFR</italic> mutation. Among surgical specimens, reflex <italic>EGFR</italic> test was performed in 181 (80%) of 225 and 35 cases (19%) were <italic>EGFR</italic> mutant. The majority of patients had not received adjuvant chemotherapy (<italic>N</italic>=174, 77%) or adjuvant radiotherapy (N=201, 89%). Of 49 (22%) patients experiencing disease relapse, 26 (53%) received first-line systemic treatment. All <italic>EGFR</italic>-mutant relapsed patients (N=6, 12.2%) received an EGFR-TKI. Median overall survival (OS) and relapse-free survival for the entire population were not reached. Multivariate analysis for OS confirmed a significant correlation with age, female gender, <italic>EGFR</italic> status, necrosis score, perineural invasion, and relapsed disease. <italic>EGFR</italic> test costs represented 1.6-2.4% of the total costs of management per patient (€34,340).</p></sec><sec><title>Conclusions</title><p>Our results suggest that the frequency of <italic>EGFR</italic> mutations in early stage (I-III) NSCLC is similar to that of advanced stages. Reflex <italic>EGFR</italic> testing in all early-stage NSCLC at diagnosis or after surgery appears to be a valid tool to give patients the chance to benefit from targeted adjuvant treatment.</p></sec>