Background: In Brazil, cancer is the second most common cause of death. Most patients in resource-limited countries are diagnosed in advanced stages. Current guidelines advocate for EGFR mutation testing in all patients with metastatic adenocarcinoma. Tyrosine kinase inhibitors are recommended in patients with advanced or metastatic disease harboring sensitizing mutations. In Brazil, there are limited data regarding the frequency of EGFR testing and the changes in patterns of testing overtime.
Materials and methods: This was an observational, retrospective study. We obtained deidentified data from a commercial database, which included 11,684 patients with non-small cell lung cancer treated between 2011 and 2016 in both public and private settings. We analyzed the frequency of EGFR mutation testing over time. We also directly studied 3,664 tumor samples, which were analyzed between 2011 and 2013. These samples were tested for EGFR mutations through an access program to tyrosine kinase inhibitors in Brazil.
Results: Overall, 38% of patients were tested for EGFR mutations; 76% of them were seen in the private sector, and 24% were seen in the public center. The frequency of testing for EGFR mutations increased significantly over time: 13% (287/2,228 patients) in 2011, 34% (738/2,142) in 2012, 39% (822/2,092) in 2013, 44% (866/1,972) in 2014, 53% (1,165/2,184) in 2015, and 42% (1,359/3,226) in 2016. EGFR mutations were detected in 25.5% of analyzed samples (857/3,364). Deletions in Exon 19 were the most frequent mutations, detected in 54% of patients (463/857).
Conclusion: Our findings suggest that the frequency of EGFR mutation in this cohort was lower than that found in Asia but higher than in North American and Western European populations. The most commonly found mutations were in Exon 19 and Exon 21. Our study shows that fewer than half of patients are being tested and that the disparity is greater in the public sector.
Implications for practice: These data not only indicate the shortage of testing but also show that the rates of positivity in those tested seem to be higher than in other cohorts for which data have been published. This study further supports the idea that awareness and access to testing should be improved in order to improve survival rates in lung cancer in Brazil.
摘要
背景。在巴西，癌症是第二大最常见的死亡原因。在资源有限的国家，大多数患者诊断癌症均在晚期。当前指南主张对所有转移性腺癌的患者进行 EGFR 突变检测。对于敏感突变的晚期或转移性疾病患者，建议使用酪氨酸激酶抑制剂。在巴西，长期以来有关 EGFR 检测频率以及检测模式变化的数据有限。
材料和方法。这是一项观察性、回顾性研究。我们从商业数据库中获取了不包含识别信息的数据，其中包括 11 684 名在 2011 年至 2016 年期间在公立和私立医院中接受治疗的非小细胞肺癌患者。我们分析了长期以来 EGFR 突变检测的频率。我们还对在 2011 年至 2013 年期间已经过分析的 3 664 个肿瘤样本进行了直接研究。通过巴西的酪氨酸激酶抑制剂获取计划，对这些样本进行 EGFR 突变检测。
结果。总体而言，38% 的患者接受了 EGFR 突变检测；其中，76% 的患者在私立医院看诊，24% 的患者在公立中心看诊。随着时间的推移，EGFR 突变检测的频率显著增加:2011 年为 13%(287/2 228 名患者)，2012 年为 34%(738/2 142 名患者)，2013 年为 39%(822/2 092 名患者)，2014 年为 44%(866/1 972 名患者)，2015 年为 53%(1 165/2 184 名患者)，2016 年为 42%(1 359/3 226 名患者)。在 25.5% 经过分析的样本(857/3 364 个样本)中检测到 EGFR 突变。第19 外显子缺失是最常见的突变，已在 54% 的患者(463/857 名患者)中检测到。
结论。我们的研究结果表明，此队列中的 EGFR 突变频率低于在亚洲人口中发生的频率，但高于在北美和西欧人口中发生的频率。最常发生的突变出现在第 19 外显子和第 21 外显子中。我们的研究显示，接受检测的患者少于半数，而且，这种差异在公立机构中更大。
实践意义:这些数据不仅表明检测不足，而且还显示出这些接受检测的患者中的阳性率似乎高于其他已发布数据的队列中的阳性率。本研究进一步支持这样的观点:为了提高巴西肺癌患者的生存率，应该增加人们对检测的认识和使用。
Keywords: Brazil; EGFR mutations; Global health; Lung adenocarcinoma.
© AlphaMed Press 2018.