title: Inequalities in lung cancer: a world of EGFR.
abstract: Epidermal growth factor receptor gene (EGFR) mutation status has emerged as a crucial issue in lung cancer management. Availability and cost of tests and tyrosine kinase inhibitors (TKIs) may vary as a function of country development.We conducted a prospective specialist opinion survey to map EGFR test and EGFR-TKI availability and detect associations with the Human Development Index (HDI). A questionnaire was sent to specialists in thoracic oncology in all United Nations Member States.We obtained responses from 74 countries, comprising 78% of the worldwide population. Nonresponding countries had significantly lower HDI rank than responding countries. EGFR mutation analysis was routinely available in 57 countries (70% of the worldwide population). The cost of the test was <US$500 in 49 countries (42.5% of the worldwide population). Test availability and cost were both significantly linked to HDI. Erlotinib, gefitinib, afatinib and icotinib were routinely available in 75%, 66%, 31% and 23% of the worldwide population, respectively, also associated with HDI.EGFR mutation testing and EGFR-TKIs are widely accessible in routine practice worldwide. However, there are large discrepancies in access to this innovative treatment path and in its cost for patients as a function of country development.
authors.affiliation: Dept of Respiratory Medicine and Thoracic Oncology, Lyon Sud Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France.
authors.forename: Mélodie
authors.initials: M
authors.lastname: Carbonnaux
authors.affiliation: Dept of Respiratory Medicine and Thoracic Oncology, Lyon Sud Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France EMR3738 Therapeutic Targeting in Oncology, Faculty of Medicine Lyon-Sud Charles Mérieux, Lyon 1 University, Lyon, France.
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Souquet
authors.affiliation: Head of the European Respiratory Society Thoracic Oncology Assembly, Dept of Intensive Care and Oncological Emergencies and Thoracic Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Anne-Pascale
authors.initials: AP
authors.lastname: Meert
authors.affiliation: Secretary of the European Respiratory Society Thoracic Oncology Assembly, Pulmonology and Thoracic Oncology Dept, Lille University Hospital, Lille, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Scherpereel
authors.affiliation: Representative of the Thoracic Society of Australia and New Zealand, Dept of Thoracic Medicine, Concord Repatriation General Hospital, Sydney, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Peters
authors.affiliation: Dept of Respiratory Medicine and Thoracic Oncology, Lyon Sud Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France EMR3738 Therapeutic Targeting in Oncology, Faculty of Medicine Lyon-Sud Charles Mérieux, Lyon 1 University, Lyon, France sebastien.couraud@chu-lyon.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Couraud
mesh_terms: D000077716:Afatinib; D043844:Crown Ethers / Q000191:economics / Q000627:therapeutic use; D004252:DNA Mutational Analysis; D066246:ErbB Receptors / Q000235:genetics*; D000069347:Erlotinib Hydrochloride / Q000191:economics / Q000627:therapeutic use; D000077156:Gefitinib; D005843:Geography; D014943:Global Health; D017048:Health Care Costs; D000069576:Health Equity; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000235:genetics*; D008495:Medical Oncology; D009154:Mutation; D011446:Prospective Studies; D047428:Protein Kinase Inhibitors / Q000191:economics / Q000627:therapeutic use; D011799:Quinazolines / Q000191:economics / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D043844:Crown Ethers; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000077716:Afatinib; C531470:icotinib; D000069347:Erlotinib Hydrochloride; C512478:EGFR protein, human; D066246:ErbB Receptors; D000077156:Gefitinib