AUTHOR=Khiewngam Khantong , Oranratnachai Songporn , Kamprerasart Kaettipong , Kunakorntham Patratorn , Sanvarinda Pimtip , Trachu Narumol , Pimsa Pongput , Wiwitkeyoonwong Jirapath , Thamrongjirapat Thanaporn , Dejthevaporn Thitiya , Sirachainan Ekaphop , Reungwetwattana Thanyanan 

TITLE=Healthcare coverage affects survival of EGFR-mutant Thai lung cancer patients

JOURNAL=Frontiers in Oncology

VOLUME=13

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1047644

DOI=10.3389/fonc.2023.1047644

ISSN=2234-943X

ABSTRACT=<sec><title>Background</title><p>Despite significant benefits of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) treatment in patients with <italic>EGFR</italic>-mutated NSCLC, access remains limited in Thailand and elsewhere.</p></sec><sec><title>Methods</title><p>Retrospective analysis of patients with locally advanced/recurrent NSCLC and known <italic>EGFR</italic> mutation (<italic>EGFR</italic>m) status treated at Ramathibodi Hospital (2012–2017). Prognostic factors for overall survival (OS), including treatment type and healthcare coverage, were analyzed using Cox regression.</p></sec><sec><title>Results</title><p>Of 750 patients, 56.3% were <italic>EGFR</italic>m-positive. After first-line therapy (n=646), 29.4% received no subsequent (second-line) treatment. EGFR-TKI-treated <italic>EGFR</italic>m-positive patients survived significantly longer than <italic>EGFR</italic>m-negative patients without EGFR-TKIs (median OS [mOS] 36.4 vs. 11.9 months; hazard ratio HR=0.38 [95%CI 0.32–0.46], <italic>P</italic>&lt;0.001). Cox regression indicated significantly longer OS in patients with comprehensive healthcare coverage that included reimbursement of EGFR-TKIs, versus basic coverage (mOS 27.2 vs. 18.3 months; adjusted HR=0.73 [95%CI 0.59–0.90]). Compared with best supportive care (BSC; reference), EGFR-TKI-treated patients survived significantly longer (mOS 36.5 months; adjusted HR (aHR)=0.26 [95%CI 0.19–0.34]), and versus chemotherapy alone (14.5 months; aHR=0.60 [95%CI 0.47–0.78]). In <italic>EGFR</italic>m-positive patients (n=422), relative survival benefit of EGFR-TKI treatment remained highly significant (aHR[EGFR-TKI]=0.19 [95%CI 0.12–0.29]; aHR(chemotherapy only)=0.50 [95%CI 0.30–0.85]; reference:BSC), indicating that healthcare coverage (reimbursement) affected treatment choice and survival.</p></sec><sec><title>Conclusion</title><p>Our analysis describes <italic>EGFR</italic>m prevalence and survival benefit of EGFR-TKI therapy for <italic>EGFR</italic>m-positive NSCLC patients treated from 2012–2017, one of the largest such Thai datasets. Together with research by others, these findings contributed evidence supporting the decision to broaden erlotinib access on healthcare schemes in Thailand from 2021, demonstrating the value of local real-world outcome data for healthcare policy decision-making.</p></sec>