Authors' objectives: A subset of non-small cell lung cancers (NSCLCs) acquire activating mutations in the epidermal growth factor receptor (EGFR) gene which drives cancer cell growth. EGFR tyrosine kinase inhibitors (TKIs) block this signalling and produce a dramatic response in a small proportion of patients (10-12% in Europeans and 30-40% in Asians). The prevalence of EGFR mutations in the New Zealand lung cancer population is unknown, and may vary between ethnic groups. These mutations are found mainly in the adenocarcinoma histology, and at lower rates in other histologies. Erlotinib (an EGFR TKI) has been funded since 2010, initially for all patients who had previously had chemotherapy (i.e. as second-line treatment), regardless of EGFR mutation status. In August 2012, when PHARMAC approved gefitinib (an EGFR TKI) available before chemotherapy (first-line) only in those with a demonstrable EGFR mutation. EGFR TKIs produce response rates of 58 – 83% and median survival of ~ 23.3 months in people with EGFR mutations. Traditional chemotherapy has a 20 - 30% response rate and extends median survival from ~5 months to ~12 months. EGFR mutation testing and EGFR TKIs are an example of co-dependent technologies. The drug is only as effective as expected if the testing platform is reliable at identifying patients who are likely to respond to treatment, and therefore clinical outcomes are dependent on both the test and drug.

Authors' recommendations: EGFR mutation testing's clinical importance is derived from its ability to identify individuals most likely to benefit from EGFR TKIs. Its clinical effectiveness is therefore related directly to the benefit derived from the medication. As described earlier there is international consensus that EGFR TKIs should be offered as first-line treatment in EGFR mutant NSCLC. The NHC recommendations were developed by a clinical Working Group (WG) and aimed to produce recommendations both clinically sound and as cost-effective as possible. It provided guidance in six different areas.

Project Status: Completed

Year Published: 2015

URL for published report: http://nhc.health.govt.nz/epidermal-growth-factor-receptor-gene-mutation-analysis-testing-assessment

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: New Zealand

Organisation Name: New Zealand National Health Committee

Contact Address: National Health Committee, PO Box 5013, 6145 Wellington New Zealand Tel: +64 4 496 2120

Contact Name: nhc_info@nhc.govt.nz

Contact Email: nhc_info@nhc.govt.nz

Copyright: New Zealand National Health Committee (NHC)