New Study of Canadian Oncologists Shines Light on Lung Cancer Mutation Testing and Treatment Trends

Results highlight genetic mutation testing levels are high, but there's room for improvement, particularly when it comes to subtype analysis

BURLINGTON, ON, April 17, 2015 /CNW/ - Results from a new international study of lung cancer oncologists shows genetic mutation testing rates are high in Canada, but we still lag behind several other countries internationally.  Mutation testing is the first step to ensure patients receive the most effective treatment that targets the genetic make-up of their lung cancer.

The survey results were presented today as a late-breaking abstract at the 2015 European Lung Cancer Conference in Geneva, Switzerland.

According to the study, 71 per cent of newly diagnosed advanced non-small cell lung cancer (NSCLC) patients in Canada were tested for EGFR mutations prior to first line therapy.¹  This compares to 77 per cent in the U.S. and U.K.², and 81 per cent internationally.³ But when it comes down to it, one in four (28 per cent) Canadian patients with NSCLC who are tested for EGFR mutations actually start treatment before getting their test results back.⁴ 

This is important because lung cancer is not just one disease – there are many different genetic mutations, each type requiring a unique approach to treatment.  For example, the epidermal growth factor receptor (EGFR) gene mutation occurs in one out of five NSCLC cases – the most common type of lung cancer – and people who never smoked, women, and East Asians are all at a higher risk for EGFR mutations.⁵

"The goal is for EVERY lung cancer patient in Canada to be tested at diagnosis so they can receive the most appropriate treatment possible that is specifically targeted to their disease or tumour type," said Shem Singh, Executive Director of Lung Cancer Canada.

According to the study, physicians reported that the main reasons for not testing all patients, aside from tumour histology, were: insufficient tissue or uncertainty of sufficient tissue (62 per cent)⁶, poor performance status (46 per cent)⁷, patients were anxious to start treatment (25 per cent)⁸ and test results took too long to come (20 per cent).⁹

Knowing EGFR status before starting treatment can mean the difference between using a treatment that has demonstrated improved quality of life and even prolonged overall survival compared to standard chemotherapy.^10,11

"Molecular diagnosis of lung cancer is now the standard of care for the appropriate management of patients afflicted with this disease," said Dr. Normand Blais, medical oncologist at Centre Hospitalier de l'Université de Montréal. "In Canada, currently approved treatments can be prescribed more specifically with the knowledge of the presence of an EGFR mutation or of an ALK translocation in the tumour, this molecular information should be obtained as soon as possible and preferentially before the start of first line treatments. Two elements are important in this new era of adapted treatment. Firstly, obtaining adequate biopsies from the moment of the initial work up and secondly,  involving the whole lung cancer investigation and treatment team to work together in order to streamline the diagnostic process."

He added, "In short: better diagnosis leads to better treatment selection."

According to the study, more than half (56 per cent)¹² of Canadian oncologists said prolonging survival is the most important therapy goal in first line treatment of NSCLC. One in two (50 per cent)¹³ considered mutation subtypes and made their therapy decisions based on the subtype.  However, still more than one third (34 per cent) of oncologists in Canada were not considering this specific level of detail.¹⁴  This is despite evidence that a targeted treatment can extend overall survival of patients with the most common type of mutation (Del 19) when compared to chemotherapy.¹⁵

Lung Cancer Landscape in Canada
In Canada, lung cancer is the number one cancer killer.¹⁶  One in every 12 men and one in every 14 women will develop lung cancer during their lifetime.¹⁷  NSCLC is the most common form, accounting for more than 85 per cent of all lung cancer diagnoses.¹⁸  Twenty per cent of NSCLC cases are EGFR mutation positive¹⁹ and of that, between 10 and 15 per cent of Caucasians and approximately 40 per cent of Asians have EGFR mutations.²⁰

About the Study
The study was conducted by Kantar Health from December 2014 to January 2015 in 10 countries including Canada, France, Germany, Italy, Japan, South Korea, Spain, Taiwan, U.K. and U.S.  It assessed the prevalence of EGFR mutation testing internationally, attitudes and barriers to testing, and how test results affect treatment choice.  The study used quantitative online interviews targeting oncologists treating patients with advanced / metastatic (stage IIIb/IV) NSCLC with anti-cancer medications. In total, 562 oncologists were surveyed (41 from Canada) through free recruitment of respondents from Sermo physician panels. The study was sponsored by Boehringer Ingelheim.

About Boehringer Ingelheim (Canada) Ltd.
The Boehringer Ingelheim group is one of the world's 20 leading pharmaceutical companies. Headquartered in Ingelheim, Germany, Boehringer Ingelheim operates globally with 142 affiliates and a total of more than 47,400 employees. The focus of the family-owned company, founded in 1885, is researching, developing, manufacturing and marketing new medications of high therapeutic value for human and veterinary medicine.

Taking social responsibility is an important element of the corporate culture at Boehringer Ingelheim. This includes worldwide involvement in social projects, such as the initiative "Making more Health" and caring for the employees. Respect, equal opportunities and reconciling career and family form the foundation of the mutual cooperation. In everything it does, the company focuses on environmental protection and sustainability.

In 2013, Boehringer Ingelheim achieved net sales of about 14.1 billion euros. R&D expenditure corresponds to 19.5 per cent of its net sales.

The Canadian headquarters of Boehringer Ingelheim was established in 1972 in Montreal, Quebec and is now located in Burlington, Ontario. Boehringer Ingelheim employs more than 550 people across Canada. For more information please visit www.boehringer-ingelheim.ca.

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¹ Kantar Health, NSCLC EGFR Testing OS, Dec - Jan 2015, Data Tables, Table Q3_1
² Kantar Health, NSCLC EGFR Testing OS, Dec - Jan 2015, Data Tables, Table Q3_1 
³ Kantar Health, NSCLC EGFR Testing OS, Dec - Jan 2015, Data Tables, Table Q3_1
⁴ Kantar Health, NSCLC EGFR Testing OS, Dec - Jan 2015, Data Tables, Q3A_1
⁵ Pao W, Miller VA. Epidermal growth factor receptor mutations, small-molecule kinase inhibitors, and non-small-cell lung cancer: current knowledge and future directions. J Clin Oncol 2005;23:2556-2568, Page 2561
⁶ Kantar Health, NSCLC EGFR Testing OS, Dec - Jan 2015, Data Tables, Table Q5
⁷ Kantar Health, NSCLC EGFR Testing OS, Dec - Jan 2015, Data Tables, Table Q5
⁸ Kantar Health, NSCLC EGFR Testing OS, Dec - Jan 2015, Data Tables, Table Q5
⁹ Kantar Health, NSCLC EGFR Testing OS, Dec - Jan 2015, Data Tables, Table Q5
¹⁰ Lindeman NI, Cagle PT, Beasley MB, et al. Molecular Testing Guideline for Selection of Lung Cancer Patients for EGFR and ALK Tyrosine Kinase Inhibitors: Guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology. J Thorac Oncol 2013 ;8:823-59
¹¹ Yang J, Sequist L et al. Overall survival (OS) In patients with advanced non-small cell lung cancer (NSCLC) harbouring common (Del19/L858R) Epidermal Growth Factor Receptor mutations (EGFR mut): pooled analysis of two large open-label phase III studies (LUX-Lung 3 [LL3] and LUX-Lung 6 [LL6] comparing afatinib with chemotherapy. Abstract #8004 presented at 2014 American Society of Clinical Oncology, 50th Annual Meeting, 30 May–3 June 2014, Chicago, IL, USA
¹² Kantar Health, NSCLC EGFR Testing OS, Dec - Jan 2015, Data Tables, Table Q14_1
¹³ Kantar Health, NSCLC EGFR Testing OS, Dec - Jan 2015, Data Tables, Table Q6, Q7
¹⁴ Kantar Health, NSCLC EGFR Testing OS, Dec - Jan 2015, Data Tables, Table Q6
¹⁵ Yang J, Sequist L et al. Overall survival (OS) In patients with advanced non-small cell lung cancer (NSCLC) harbouring common (Del19/L858R) Epidermal Growth Factor Receptor mutations (EGFR mut): pooled analysis of two large open-label phase III studies (LUX-Lung 3 [LL3] and LUX-Lung 6 [LL6] comparing afatinib with chemotherapy. Abstract #8004 presented at 2014 American Society of Clinical Oncology, 50th Annual Meeting, 30 May–3 June 2014, Chicago, IL, US
¹⁶ Canadian Cancer Society's Steering Committee: Canadian Cancer Statistics 2014. Toronto,ON: Canadian Cancer Society; 2014, Page 6
¹⁷ Canadian Cancer Society's Steering Committee: Canadian Cancer Statistics 2014. Toronto,ON: Canadian Cancer Society; 2014, Page 17
¹⁸ Torok, Szilvia, et al. "Lung cancer in never smokers." Future Oncology. 7.10 (2011): 1196
¹⁹ Pao W, Miller VA. Epidermal growth factor receptor mutations, small-molecule kinase inhibitors, and non-small-cell lung cancer: current knowledge and future directions. J Clin Oncol 2005;23:2556-2568, Page 2561
²⁰ Quest Diagnostics. Lung Cancer Mutation Panel (EGFR, KRAS, ALK). Available at: http://questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?fn=Lung/TS_LungCancerMutation_Panel.htm. Last accessed April 2015. Page 2

SOURCE Boehringer Ingelheim (Canada) Ltd.

Image with caption: "Lung cancer mutation testing and treatment trends in Canada (CNW Group/Boehringer Ingelheim (Canada) Ltd.)". Image available at: http://photos.newswire.ca/images/download/20150417_C7861_PHOTO_EN_14398.jpg

Sheba Zaidi / Morgan Cates, Environics Communications, 416-969-2652 / 2789, [email protected] /[email protected]