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

Publication ,  Journal Article
Lynch, JA; Berse, B; Chun, D; Rivera, D; Filipski, KK; Kulich, S; Viernes, B; DuVall, SL; Kelley, MJ
Published in: Clin Lung Cancer
July 2017

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.

Duke Scholars

Published In

Clin Lung Cancer

DOI

EISSN

1938-0690

Publication Date

July 2017

Volume

18

Issue

4

Start / End Page

401 / 409

Location

United States

Related Subject Headings

  • Young Adult
  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Survival Analysis
  • Oncology & Carcinogenesis
  • Mutation
  • Middle Aged
  • Male
  • Lung Neoplasms
 

Citation

APA
Chicago
ICMJE
MLA
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Lynch, J. A., Berse, B., Chun, D., Rivera, D., Filipski, K. K., Kulich, S., … Kelley, M. J. (2017). Epidermal Growth Factor Receptor Mutational Testing and Erlotinib Treatment Among Veterans Diagnosed With Lung Cancer in the United States Department of Veterans Affairs. Clin Lung Cancer, 18(4), 401–409. https://doi.org/10.1016/j.cllc.2016.11.018
Lynch, Julie A., Brygida Berse, Danielle Chun, Donna Rivera, Kelly K. Filipski, Scott Kulich, Benjamin Viernes, Scott L. DuVall, and Michael J. Kelley. “Epidermal Growth Factor Receptor Mutational Testing and Erlotinib Treatment Among Veterans Diagnosed With Lung Cancer in the United States Department of Veterans Affairs.Clin Lung Cancer 18, no. 4 (July 2017): 401–9. https://doi.org/10.1016/j.cllc.2016.11.018.
Lynch, Julie A., et al. “Epidermal Growth Factor Receptor Mutational Testing and Erlotinib Treatment Among Veterans Diagnosed With Lung Cancer in the United States Department of Veterans Affairs.Clin Lung Cancer, vol. 18, no. 4, July 2017, pp. 401–09. Pubmed, doi:10.1016/j.cllc.2016.11.018.
Lynch JA, Berse B, Chun D, Rivera D, Filipski KK, Kulich S, Viernes B, DuVall SL, Kelley MJ. Epidermal Growth Factor Receptor Mutational Testing and Erlotinib Treatment Among Veterans Diagnosed With Lung Cancer in the United States Department of Veterans Affairs. Clin Lung Cancer. 2017 Jul;18(4):401–409.
Journal cover image

Published In

Clin Lung Cancer

DOI

EISSN

1938-0690

Publication Date

July 2017

Volume

18

Issue

4

Start / End Page

401 / 409

Location

United States

Related Subject Headings

  • Young Adult
  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Survival Analysis
  • Oncology & Carcinogenesis
  • Mutation
  • Middle Aged
  • Male
  • Lung Neoplasms