Epidermal Growth Factor Receptor Mutational Testing and Erlotinib Treatment Among Veterans Diagnosed With Lung Cancer in the United States Department of Veterans Affairs.

Abstract:

INTRODUCTION:We examined mutational testing of the epidermal growth factor gene (EGFR) and erlotinib treatment among veterans diagnosed with non-small-cell lung cancer in the United States Department of Veterans Affairs (VA). Our objectives were to identify the prevalence of clinically actionable EGFR mutations, to determine whether testing and treatment were guideline concordant, to evaluate the impact of testing and treatment on survival, and to estimate the rate of testing. PATIENTS AND METHODS:Test results were linked to electronic health records from VA Corporate Data Warehouse and the VA Central Cancer Registry. We analyzed patient demographic and clinical characteristics, prevalence of EGFR mutations, and timing of EGFR mutational testing and erlotinib treatment based on pharmacy records. Overall survival was assessed by Kaplan-Meier analysis. RESULTS:Among 973 patients tested at 70 VA medical centers between 2011 and 2013, 64 (7%) had sensitizing EGFR mutations, 694 (71%) were EGFR wild type, and 168 (17%) had clinically insignificant polymorphisms or variants of unknown significance. Results were not documented in 47 tests (5%). Erlotinib administration was in agreement with test results in 843 cases (87%). CONCLUSION:Veterans have a much lower rate of sensitizing EGFR mutations than the reported average of 10% to 15%, which correlates with a high rate of smoking among veterans. This may partially explain clinicians' reluctance to prescribe EGFR testing, which results in underutilization. Although test results appear to have influenced erlotinib treatment decisions, we documented a substantial number of cases where treatment was not applied in accordance with clinical guidelines, potentially resulting in worse outcomes and unnecessary cost.

journal_name

Clin Lung Cancer

journal_title

Clinical lung cancer

authors

Lynch JA,Berse B,Chun D,Rivera D,Filipski KK,Kulich S,Viernes B,DuVall SL,Kelley MJ

doi

10.1016/j.cllc.2016.11.018

subject

Has Abstract

pub_date

2017-07-01 00:00:00

pages

401-409

issue

4

eissn

1525-7304

issn

1938-0690

pii

S1525-7304(16)30372-2

journal_volume

18

pub_type

杂志文章
  • Recent Advances and Future Strategies for Immune-Checkpoint Inhibition in Small-Cell Lung Cancer.

    abstract::Small-cell lung cancer (SCLC) is distinguished from non-small-cell lung cancer by its rapid growth and more frequent metastases. Although patients with SCLC are highly responsive to chemotherapy and radiation therapy, long-term prognosis remains poor, with relapse and disease recurrence occurring in almost all cases. ...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章,评审

    doi:10.1016/j.cllc.2016.07.004

    authors: Chae YK,Pan A,Davis AA,Mohindra N,Matsangou M,Villaflor V,Giles F

    更新日期:2017-03-01 00:00:00

  • Transcriptional regulation of IRS5/DOK4 expression in non-small-cell lung cancer cells.

    abstract::The insulin-receptor substrate family plays important roles in cellular growth, signaling, and survival. Two new members of this family have recently been isolated: IRS5/Dok4 and IRS6/Dok5. This study examines the expression of IRS5/DOK4 in a panel of lung cancer cell lines and tumor specimens. The results demonstrate...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.3816/CLC.2008.n.053

    authors: Gray SG,Al-Sarraf N,Baird AM,Gately K,McGovern E,O'Byrne KJ

    更新日期:2008-11-01 00:00:00

  • Clinical implications and added costs of incidental findings in an early detection study of lung cancer by using low-dose spiral computed tomography.

    abstract:INTRODUCTION:To prospectively evaluate the frequency and spectrum of incidental findings (IF) in a 5-year lung cancer screening program with low-dose spiral computed tomography (CT) and to estimate the additional costs of their imaging workup incurred from subsequent radiologic follow-up evaluation. MATERIALS AND METH...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2012.05.005

    authors: Priola AM,Priola SM,Giaj-Levra M,Basso E,Veltri A,Fava C,Cardinale L

    更新日期:2013-03-01 00:00:00

  • Analysis of lung cancer patients enrolled in CTEP (cancer therapy evaluation program)-sponsored phase I trials.

    abstract:INTRODUCTION:A recent review of phase I trials suggests that participation in these trials can be associated with clinical benefit and the rate of drug-related deaths is low. We conducted an analysis of the Cancer Therapy Evaluation Program (CTEP)-sponsored phase I trials to assess the outcomes of lung cancer patients ...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2011.03.022

    authors: Gadgeel SM,Ivy P,Chen W,Mauer J,Smith D,Lorusso P

    更新日期:2011-07-01 00:00:00

  • The Effect of Primary Care Physician Knowledge of Lung Cancer Screening Guidelines on Perceptions and Utilization of Low-Dose Computed Tomography.

    abstract:INTRODUCTION:Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is recommended by the U.S. Preventive Services Task Force (USPSTF) in high-risk patients, but a minority of eligible people are screened. It is not clear whether knowledge of USPSTF recommendations among primary care physicians (PCP) affe...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2017.05.013

    authors: Raz DJ,Wu GX,Consunji M,Nelson RA,Kim H,Sun CL,Sun V,Kim JY

    更新日期:2018-01-01 00:00:00

  • Third-line chemotherapy in small-cell lung cancer: an international analysis.

    abstract:INTRODUCTION:Small-cell lung cancer is an aggressive disease for which the mainstay of treatment is chemotherapy. Despite good initial responses most patients will relapse. Some will receive second-line therapy with clinical benefit, but for third-line chemotherapy there is little evidence to guide treatment decisions ...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章,多中心研究

    doi:10.1016/j.cllc.2013.11.003

    authors: Simos D,Sajjady G,Sergi M,Liew MS,Califano R,Ho C,Leighl N,White S,Summers Y,Petrcich W,Wheatley-Price P

    更新日期:2014-03-01 00:00:00

  • Classifications of n2 non-small-cell lung cancer based on the number and rate of metastatic mediastinal lymph nodes.

    abstract:BACKGROUND:Subdivisions of N2 non-small-cell lung cancer (NSCLC) cases based on metastatic status of mediastinal and non-mediastinal lymph nodes have been proposed. This study aimed to evaluate N2 disease classification by mediastinal lymph nodes alone. PATIENTS AND METHODS:We reviewed 187 patients with NSCLC pN1-N2 w...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2013.04.012

    authors: Ito M,Yamashita Y,Tsutani Y,Misumi K,Harada H,Miyata Y,Okada M

    更新日期:2013-11-01 00:00:00

  • Intercalated Chemotherapy and Epidermal Growth Factor Receptor Inhibitors for Patients With Advanced Non-Small-cell Lung Cancer: A Systematic Review and Meta-analysis.

    abstract::Randomized clinical trials (RCTs) of concurrent epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) plus chemotherapy for unselected patients with advanced non-small-cell lung cancer (NSCLC) produced negative results. Intercalated administration could avoid the reduction of chemotherapy activity du...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章,meta分析,评审

    doi:10.1016/j.cllc.2016.08.006

    authors: La Salvia A,Rossi A,Galetta D,Gobbini E,De Luca E,Novello S,Di Maio M

    更新日期:2017-01-01 00:00:00

  • Utilization of Surgery and Its Impact on Survival in Patients With Early Stage Small-cell Lung Cancer in the United States.

    abstract:INTRODUCTION:For patients with T1 or T2 N0 M0 small-cell lung cancer (SCLC), lobectomy followed by chemotherapy is the standard of care. However, because of its tendency for early dissemination, patients are often treated with concurrent chemo-radiation without surgery. This study was conducted to evaluate the utilizat...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2019.07.013

    authors: Uprety D,Arjyal L,Vallatharasu Y,Bista A,Borgert A,Fitzsimmons AJ,Parsons BM

    更新日期:2020-03-01 00:00:00

  • Tirapazamine with cisplatin and vinorelbine in patients with advanced non-small-cell lung cancer: a phase I/II study.

    abstract::This phase I/II study was conducted to evaluate the safety and efficacy of tirapazamine in combination with cisplatin and vinorelbine for patients with advanced-stage IIIB/IV chemonaive non-small-cell lung cancer. Seventy patients with a Karnofsky performance status of > or = 60% were included. In the phase I part of ...

    journal_title:Clinical lung cancer

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.3816/clc.2005.n.008

    authors: Gatineau M,Rixe O,Chevalier TL

    更新日期:2005-03-01 00:00:00

  • First-line chemotherapy for advanced-stage non-small-cell lung cancer: focus on docetaxel.

    abstract::Systemic chemotherapy results in modest improvements in survival and quality of life for patients with advanced-stage non-small-cell lung cancer (NSCLC). Administration of a platinum compound in combination with a taxane (paclitaxel or docetaxel), gemcitabine, vinorelbine, or irinotecan is considered optimal first-lin...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章,评审

    doi:10.3816/clc.2005.s.014

    authors: Ramalingam S

    更新日期:2005-12-01 00:00:00

  • Pathological examination and the reporting of lung cancer specimens.

    abstract::The Lung Cancer Disease Site Group (DSG) of the Cancer Care Ontario Practice Guidelines Initiative first met in January of 1994. Included in the membership were three pathologists who, with the other members of the DSG, felt that a useful contribution to the work of the group would be a recommendation on standardized ...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.3816/clc.2000.n.008

    authors: Chamberlain DW,Wenckebach GF,Alexander F,Fraser RS,Kolin A,Newman T

    更新日期:2000-05-01 00:00:00

  • Nine-year Experience: Prophylactic Cranial Irradiation in Extensive Disease Small-cell Lung Cancer.

    abstract:BACKGROUND:In 2007, the European Organization for Research and Treatment of Cancer (EORTC) study (ClinicalTrials.gov identifier, NCT00016211) demonstrated a beneficial effect on overall survival (OS) with the use of prophylactic cranial irradiation (PCI) for extensive disease (ED) small-cell lung cancer (SCLC). Neverth...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2016.11.012

    authors: Bernhardt D,Adeberg S,Bozorgmehr F,Opfermann N,Hoerner-Rieber J,Repka MC,Kappes J,Thomas M,Bischoff H,Herth F,Heußel CP,Debus J,Steins M,Rieken S

    更新日期:2017-07-01 00:00:00

  • Management of Central Nervous System Metastases in Patients With Advanced Anaplastic Lymphoma Kinase-Rearranged Non-Small-Cell Lung Cancer During Crizotinib Treatment.

    abstract:BACKGROUND:Central nervous system (CNS) progression is a common manifestation of acquired resistance to crizotinib in anaplastic lymphoma kinase (ALK)-rearranged non-small-cell lung cancer (NSCLC). However, an optimal tailored treatment approach has not been established in patients with CNS failure during crizotinib tr...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2019.06.013

    authors: Zhao Y,Zhang B,Wang S,Qiao R,Xu J,Zhang L,Zhang Y,Han B

    更新日期:2019-11-01 00:00:00

  • Gefitinib as first-line treatment in elderly epidermal growth factor receptor-mutated patients with advanced lung adenocarcinoma: results of a Nagano Lung Cancer Research Group study.

    abstract:UNLABELLED:Efficacy of first-line gefitinib for elderly epidermal growth factor receptor mutated patients with lung adenocarcinoma is uncertain. This study was aimed to investigate efficacy of gefitinib for such population. The primary endpoint was response rate (RR) and at least 12 cases were needed. Overall RR was 59...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2011.02.004

    authors: Asami K,Koizumi T,Hirai K,Ameshima S,Tsukadaira A,Morozumi N,Morikawa A,Atagi S,Kawahara M

    更新日期:2011-11-01 00:00:00

  • Reliability of Small Biopsy Samples Compared With Resected Specimens for the Determination of Programmed Death-Ligand 1 Expression in Non--Small-Cell Lung Cancer.

    abstract:BACKGROUND:Several studies have assessed the expression of programmed death-ligand 1 (PD-L1) in resected surgical specimens of non-small-cell lung cancer (NSCLC). However, the expression of PD-L1 in smaller biopsy samples of advanced NSCLC has not been reported. PATIENTS AND METHODS:A total of 79 patients with NSCLC a...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2015.03.008

    authors: Kitazono S,Fujiwara Y,Tsuta K,Utsumi H,Kanda S,Horinouchi H,Nokihara H,Yamamoto N,Sasada S,Watanabe S,Asamura H,Tamura T,Ohe Y

    更新日期:2015-09-01 00:00:00

  • Placebo-controlled trial of bexarotene, a retinoid x receptor agonist, as maintenance therapy for patients treated with chemotherapy for advanced non-small-cell lung cancer.

    abstract::This study was designed as a multicenter, randomized, double-blind, placebo-controlled trial. Patients were randomized by center to placebo (16 patients, 31%), oral bexarotene 300 mg/m2/day (21 patients, 40%), or oral bexarotene 600 mg/m2/day (15 patients, 29%) following demonstration of stable or responsive disease a...

    journal_title:Clinical lung cancer

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.3816/clc.2001.n.005

    authors: Rizvi N,Hawkins MJ,Eisenberg PD,Yocum RC,Reich SD,Ligand L1069-20 Working Group.

    更新日期:2001-02-01 00:00:00

  • Clinical significance of downstaging in patients with limited-disease small-cell lung cancer.

    abstract:BACKGROUND:We investigated the effect of downstaging on OS in LD-SCLC patients treated with first-line treatment. PATIENTS AND METHODS:We retrospectively reviewed 210 LD-SCLC patients who were treated with first-line treatment at Seoul National University Hospital between April 1999 and November 2012. Compared with in...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2013.09.003

    authors: Go SI,Keam B,Kim TM,Lee SH,Kim DW,Kim HJ,Wu HG,Chung DH,Heo DS

    更新日期:2014-03-01 00:00:00

  • Gemcitabine and carboplatin in advanced non small-cell lung cancer: a review.

    abstract::Both gemcitabine and carboplatin have demonstrated activity in advanced non small-cell lung cancer. The combination of gemcitabine and cisplatin has demonstrated equivalent or superior efficacy to other commonly used agents and two-drug combinations, and a recent Eastern Cooperative Oncology Group trial suggested that...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.3816/clc.2000.s.008

    authors: Masters GA

    更新日期:2000-12-01 00:00:00

  • Structural basis for hyperpermeability of tumor vessels in advanced lung adenocarcinoma complicated by pleural effusion.

    abstract:BACKGROUND:Malignant pleural effusion (MPE) has a profound impact on quality of life and survival in patients with lung cancer. Identification of the factors within the tumor and its environment that mediate MPE is still lacking. PATIENTS AND METHODS:Intratumoral microvessel density (MVD), endothelial cell and pericyt...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2013.06.007

    authors: Damianovich M,Hout Siloni G,Barshack I,Simansky DA,Kidron D,Dar E,Avivi C,Onn A

    更新日期:2013-11-01 00:00:00

  • Rationale and Design of PEMVITASTART-An Open-label Randomized Trial Comparing Simultaneous Versus Standard Initiation of Vitamin B12 and Folate Supplementation in Nonsquamous, Non-Small-cell Lung Cancer Patients Undergoing First-line Pemetrexed-based Chem

    abstract::Pemetrexed is the preferred chemotherapeutic drug for nonsquamous, non-small-cell lung cancer patients whenever the predictive molecular biomarkers for targeted therapy have either not been assessed or are absent. As per manufacturers' instructions, supplementation with folic acid (FA; folate) at a dose of 350 to 1000...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章,随机对照试验

    doi:10.1016/j.cllc.2016.11.017

    authors: Baldi M,Behera D,Kaur J,Kapoor R,Singh N

    更新日期:2017-07-01 00:00:00

  • Presence of Even a Small Ground-Glass Component in Lung Adenocarcinoma Predicts Better Survival.

    abstract:BACKGROUND:While lepidic-predominant lung adenocarcinomas are known to have better outcomes than similarly sized solid tumors, the impact of smaller noninvasive foci within predominantly solid tumors is less clearly characterized. We tested the hypothesis that lung adenocarcinomas with even a small ground-glass opacity...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2017.06.020

    authors: Berry MF,Gao R,Kunder CA,Backhus L,Khuong A,Kadoch M,Leung A,Shrager J

    更新日期:2018-01-01 00:00:00

  • Mature results of a phase II trial of gemcitabine/paclitaxel given every 2 weeks in patients with advanced non-small-cell lung cancer.

    abstract:PURPOSE:This phase II study evaluated the efficacy and toxicity of gemcitabine/paclitaxel given every 2 weeks in patients with advanced-stage non-small-cell lung cancer. Treatment with 1 previous chemotherapy regimen was allowed. Patients received gemcitabine 3000 mg/m(2) intravenously over 30 minutes and paclitaxel 15...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.3816/CLC.2007.n.010

    authors: Wozniak AJ,Belzer K,Heilbrun LK,Kucuk O,Gadgeel S,Kalemkerian GP,Venkatramanamoorthy R,Kraut MJ

    更新日期:2007-03-01 00:00:00

  • Prognostic Impact and Risk Factors of Immune-Related Pneumonitis in Patients With Non-Small-Cell Lung Cancer Who Received Programmed Death 1 Inhibitors.

    abstract:INTRODUCTION:Pneumonitis is one of the immune-related adverse events of programmed death 1 (PD-1) inhibitors that sometimes cause lethal outcomes. Although some recent reports have described PD-1 inhibitors as more effective in non-small-cell lung cancer (NSCLC) patients with immune-related adverse events than in those...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章,多中心研究

    doi:10.1016/j.cllc.2019.07.006

    authors: Fukihara J,Sakamoto K,Koyama J,Ito T,Iwano S,Morise M,Ogawa M,Kondoh Y,Kimura T,Hashimoto N,Hasegawa Y

    更新日期:2019-11-01 00:00:00

  • Clinical Impact of Frequent Surveillance Imaging in the First Year Following Chemoradiation for Locally Advanced Non-small-cell Lung Cancer.

    abstract:OBJECTIVE:Uncertainty exists regarding the optimal surveillance imaging schedule following definitive chemoradiation (CRT) for locally advanced non-small-cell lung cancer (LA-NSCLC) with regards to both frequency and modality. We sought to document the clinical impact of frequent (at least every 4 months) surveillance ...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2016.11.010

    authors: Ho QA,Harandi NK,Daly ME

    更新日期:2017-07-01 00:00:00

  • Real-World Clinical Impact of Immune Checkpoint Inhibitors in Patients With Advanced/Metastatic Non-Small Cell Lung Cancer After Platinum Chemotherapy.

    abstract:BACKGROUND:The real-world effect of anti-programmed death ligand 1 (PD-L1) therapies is unclear. We compared US patients who received second-line therapy for non-small-cell lung cancer (NSCLC) before and shortly after US Food and Drug Administration (FDA) approval of PD-L1 inhibitors. PATIENTS AND METHODS:Patients in ...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2019.04.004

    authors: Schwartzberg L,Korytowsky B,Penrod JR,Zhang Y,Le TK,Batenchuk C,Krug L

    更新日期:2019-07-01 00:00:00

  • Phase II study of sequential treatment of advanced non-small-cell lung cancer: three cycles of high-dose epirubicin plus cisplatin followed by weekly vinorelbine.

    abstract::Previous phase I, II, and III studies on high-dose epirubicin (HDEPI), alone or in combination with cisplatin (CP), indicate an interesting activity of this drug in the treatment of non-small-cell lung cancer (NSCLC). However, the toxicological profile of HDEPI limits its prolonged use. In our experience, vinorelbine ...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.3816/clc.2001.n.017

    authors: Guaraldi M,Marino A,Pannuti F,Farabegoli G,Martoni A

    更新日期:2001-08-01 00:00:00

  • Granulocyte-macrophage colony-stimulating factor gene-transfected autologous tumor cell vaccine: focus[correction to fcous] on non-small-cell lung cancer.

    abstract::Traditionally, non-small-cell lung cancer (NSCLC) is not thought of as an immunosensitive malignancy. However, recent clinical results with GVAX, a granulocyte-macrophage colony-stimulating factor (GM-CSF) gene-transduced autologous tumor vaccine, may suggest otherwise. This review summarizes immune-induced activity c...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章,评审

    doi:10.3816/clc.2003.n.027

    authors: Nemunaitis J,Nemunaitis J

    更新日期:2003-11-01 00:00:00

  • Correlations Between the Immune-related Adverse Events Spectrum and Efficacy of Anti-PD1 Immunotherapy in NSCLC Patients.

    abstract:BACKGROUND:Immune-related adverse events (irAEs) developed during immunotherapy with anti-PD-1 agents, could be a predictive surrogate marker of clinical benefit in patients with advanced non-small-cell lung cancer (NSCLC). METHODS:Patients with NSCLC, treated with anti-PD-1 agents, were retrospectively evaluated. Uni...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章,多中心研究

    doi:10.1016/j.cllc.2019.02.006

    authors: Cortellini A,Chiari R,Ricciuti B,Metro G,Perrone F,Tiseo M,Bersanelli M,Bordi P,Santini D,Giusti R,Grassadonia A,Di Marino P,Tinari N,De Tursi M,Zoratto F,Veltri E,Malorgio F,Garufi C,Russano M,Anesi C,Zeppola T,

    更新日期:2019-07-01 00:00:00

  • Clinical Impact of Gastric Acid-Suppressing Medication Use on the Efficacy of Erlotinib and Gefitinib in Patients With Advanced Non-Small-Cell Lung Cancer Harboring EGFR Mutations.

    abstract:BACKGROUND:Gastric acid-suppressing medications (AS), namely, proton pump inhibitors and histamine-2 receptor antagonists, increase gastric pH, which may reduce the absorption of the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors-erlotinib and gefitinib. PATIENTS AND METHODS:From 2008 to 2011, 130 ...

    journal_title:Clinical lung cancer

    pub_type: 杂志文章

    doi:10.1016/j.cllc.2016.01.006

    authors: Zenke Y,Yoh K,Matsumoto S,Umemura S,Niho S,Ohmatsu H,Goto K,Ohe Y

    更新日期:2016-09-01 00:00:00