title: Utilization Patterns and Trends in Epidermal Growth Factor Receptor (EGFR) Mutation Testing Among Patients With Newly Diagnosed Metastatic Lung Cancer.
abstract: Epidermal growth factor receptor (EGFR)-targeted therapy significantly improves outcomes among patients with non-small-cell lung cancer (NSCLC) whose tumors harbor sensitizing mutations. Patterns of EGFR testing have not been well-documented. The objective of this population-based study is to assess the testing pattern on a national scale.
  
  
  
  Using MarketScan 2012 to 2014 data, we identified 5842 patients newly diagnosed with metastatic lung cancer from January 2013 to June 2014 and assessed their EGFR mutation testing pattern in the 6 months after diagnosis. We further examined the testing rate among patients who received the EGFR inhibitor erlotinib. Because histology information is not available in this database, we also conducted a subgroup analysis of EGFR testing among patients who were treated with bevacizumab or pemetrexed, who are likely to have non-squamous NSCLC. Multivariable logistic regression was performed to ascertain factors associated with EGFR testing.
  
  
  
  Of 5842 patients with metastatic lung cancer, 1039 (18%) had claims for EGFR testing within 6 months of diagnosis, and 283 (5%) received erlotinib. The testing rate among patients who received erlotinib was 42%. Within a subgroup of 1685 patients treated with bevacizumab or pemetrexed, 616 (37%) underwent EGFR testing. Multivariable logistic regression showed that younger patients, female patients, patients with fewer comorbidities, and patients living in the West region were more likely to receive EGFR testing.
  
  
  
  This population-based study demonstrates low EGFR testing rates among advanced lung cancer patients in 2013 and 2014.
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: cshen@mdanderson.org.
authors.forename: Chan
authors.initials: C
authors.lastname: Shen
authors.affiliation: Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Kehl
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhao
authors.affiliation: Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: George R
authors.initials: GR
authors.lastname: Simon
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Shouhao
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000068258:Bevacizumab / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D015331:Cohort Studies; D066246:ErbB Receptors / Q000235:genetics*; D000069347:Erlotinib Hydrochloride / Q000627:therapeutic use; D005260:Female; D005820:Genetic Testing; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009154:Mutation / Q000235:genetics*; D009362:Neoplasm Metastasis; D000068437:Pemetrexed / Q000627:therapeutic use; D044382:Population Groups; D055815:Young Adult
chemical_list: D000068437:Pemetrexed; D000068258:Bevacizumab; D000069347:Erlotinib Hydrochloride; C512478:EGFR protein, human; D066246:ErbB Receptors
keywords: EGFR testing; Erlotinib; Health services research; MarketScan data; Population-based study