Incidence, outcomes and tolerance in EGFRm and ALK‐rearrangement positive NSCLC

Abstract

Introduction Non‐small‐cell lung cancer (NSCLC) is comprised of histological, genetic and molecular subtypes. Patients with mutation‐positive epidermal growth factor receptor (EGFRm) and anaplastic lymphoma kinase (ALK) gene rearrangement have been shown to have a favourable response to treatment with tyrosine kinase inhibitors (TKI), with improved survival outcomes compared to convention chemotherapy.

Aim To describe the incidence of EGFRm/ALK positive NSCLC in the selected population, assess survival and performance status, and tolerance of treatment with tyrosine kinase inhibitors.

Methods A retrospective audit including all patients who presented to the Gold Coast Health Service from January 2015 to December 2017 with NSCLC.

Results A total of 543 patients were included, with 49 found to have EGFR mutation (7.7%) or ALK rearrangement (1.2%) positive cancer. Complete clinical data was available for review in 46 patients. The mean age of the 46 patients was 67 (±2) years and 29 (63%) were female. At the time of initial diagnosis, 31 (67%) had stage IV disease and performance status was ECOG 0 in 12, I in 19, II in 7 and III in 2 patients (4 patients had missing data). Molecular analysis identified an EGFR mutation in 38 patients and ALK was positive in 7 patients. 28 patients received a tyrosine kinase inhibitors, 7 patients immunotherapy and 22 patients received conventional chemotherapy. 84% of patients with metastatic disease were treated with TKIs; many patients received chemotherapy prior to confirmation of mutation status or after progression while on TKI treatment. Adverse effects were common and was reported in 26 patients (GI in 10 patients, dermatological in 14 patients and haematological in 2 patients).

Conclusion The incidence of mutations to EGFR/ALK were lower than the national average. Side effects were common with intolerance leading to reduced dose/duration of treatment in some patients.