Title: TREATMENT PATTERNS AMONG LOWER-INCOME INDIAN PATIENTS WITH METASTATIC NON-SMALL CELL LUNG CANCER HARBORING EGFR MUTATIONS OR ALK REARRANGEMENTS
Abstract: SESSION TITLE: Practice Management and Administration Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Despite the substantial number of highly-effective targeted agents for patients with metastatic Non-Small Cell Lung Cancer (NSCLC) harboring clinically-relevant driver mutations, previous reports have indicated suboptimal rates of targeted agent (TA) prescriptions among eligible candidates in the developed world. In India, the volume of patients with advanced NSCLC is expansive while the prevalence of actionable mutations is the highest internationally. An assessment of prescription practices at a major referral center serving predominantly lower-income Indian patients is warranted. METHODS: A retrospective query of the Lung Cancer Clinic (LCC) database within the All India Institute of Medical Sciences (AIIMS) – Delhi between January 2008 and December 2019 was undertaken. Patients with (1) metastatic disease, (2) diagnoses consistent with pulmonary adenocarcinoma, (3) somatic EGFR mutations or ALK rearrangements based upon results of tumor DNA sequencing and/or cytogenetic studies, and (4) available prescription data were selected for inclusion. Baseline demographics, including socioeconomic status, were compared between patients who were prescribed TA’s and those who were not by chi-square and t-testing. RESULTS: Of the 336 patients within the LCC database who were diagnosed with pulmonary adenocarcinoma and evaluated for actionable mutations, 85 had mutations within EGFR and 30 had ALK rearrangements. Among those with EGFR mutations, 60 (70.6%) received TA’s. Patients with EGFR mutations who were prescribed TA’s were more likely to receive any anti-cancer treatment (100% vs. 64%, p < 0.001) and had a markedly lower mean smoking index (77.2 +/- 47.2 vs. 336.6 +/- 73.3, p < 0.001) compared to those who were not prescribed TA’s. Among patients with ALK rearrangements, 15 (50%) patients received TA’s. Patients with ALK rearrangements who were prescribed TA’s were more likely to undergo biopsy via bronchoscopy rather than by image-guided or surgical means (80.0% vs. 46.7%, p = 0.04), which require referrals to additional physician, compared to those who were not prescribed TA’s. No differences in age, sex, education, occupation, or income were observed between patients with actionable mutations who were prescribed TA’s and those who were not. CONCLUSIONS: Rates of TA prescriptions among patients with EGFR mutations at our center serving lower-income Indians with NSCLC is similar to those at sites in the developed world. However, rates of TA prescriptions among patients with ALK rearrangements were comparatively low. Socioeconomic status was not associated with prevalence of TA administrations. CLINICAL IMPLICATIONS: Standard precision oncology approaches are possible for Indian patients being managed by a public referral center. Accentuating the critical value of TA’s to patients harboring highly-actionable mutations may improve prescription rates. DISCLOSURES: No relevant relationships by Avneet Garg, source=Web Response No relevant relationships by Randeep Guleria, source=Web Response No relevant relationships by Hariharan Iyer, source=Web Response No relevant relationships by Deepali Jain, source=Web Response No relevant relationships by Karan Madan, source=Web Response no disclosure on file for Anant Mohan; No relevant relationships by Vishal Vashistha, source=Web Response
Publication Year: 2020
Publication Date: 2020-10-01
Language: en
Type: article
Indexed In: ['crossref']
Access and Citation
Cited By Count: 1
AI Researcher Chatbot
Get quick answers to your questions about the article from our AI researcher chatbot