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Paulo Salles



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    P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.01-12 - EGFR Mutation and Targeted Therapies: Difficulties and Disparities in Access to NSCLC Treatment in Brazil. (ID 14236)

      12:00 - 13:30  |  Author(s): Paulo Salles

      • Abstract
      • Slides

      Background

      Non-small cell lung cancer (NSCLC) is the most prevalent lung cancer subtype, commonly presenting as advanced disease at diagnosis. Epidermal growth factor mutation (EGFRm) occurs in 10-15% of Western population with advanced NSCLC and its management includes the use of mutation-driver EGFR tyrosine kinase inhibitors (EGFR-TKIs). In Brazil, patients with EGFRm NSCLC may face barriers to access EGFR test and directed-therapy; otherwise, there is a lack of national clinical data addressing this issue. This study intended to evaluate the access to molecular EGFR testing, initial treatment, and its respective response in this patients setting in public and private institutions in Brazil.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      In this retrospective cohort, patients with newly diagnosed advanced NSCLC between January and December 2014 were consecutively included. Data were collected from medical records of 10 Brazilian cancer institutions, and recorded in electronic clinical report form. Demographic data, medical history, tumor staging, pathological characteristics, treatments and outcomes were collected and analyzed. For each patient, maximum follow-up was 36 months.

      4c3880bb027f159e801041b1021e88e8 Result

      402 patients from 8 different Brazilian states were enrolled, and 391 were included in the analysis, being 236 men (60.4%). Median age was 64 years, 80% have been treated in the public and 20% in private health system; 74.9% (n = 293) were former or current smokers. The most frequent histological subtypes of NSCLC were adenocarcinoma (ADC) with 267 cases (68.3%) and squamous cell carcinoma (SqCC) with 87 cases (22.3%). Among smokers, 66.6% were diagnosed with ADC and 24.6% with SqCC; among never smokers (n = 63), 84.1% had ADC and 9.5% SqCC. Clinical staging (CS) at diagnosis was IV in 251 cases (81.6%) and locally advanced (stage IIIB) in 62 cases (18.4%). From patients diagnosed with ADC, only 52.1% (n = 139) have been tested for EGFR mutation and, of these, 21.6% (n = 30) had an EGFR activating mutation. Only 43.3% (n = 13) of those with EGFRm (n=30) received an EGFR-TKI as initial therapy, while the remaining were treated with cytotoxic chemotherapy. Based on the number of patients with EGFRm, the rate of access of EGFR-TKIs in first-line treatment was 75% in private care, compared to 31.8% in public care. Only 8 of 13 mutated patients (61.5%) treated with EGFR-TKI were evaluable for response, and the disease control rate was 62.5%.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The frequency of EGFRm in locally advanced or metastatic ADC in Brazil was comparable to previous studies. Access to EGFR test and EGFR-targeted therapies are restricted specially in public health system. In Brazil, public policies to assure a broader access to these technologies must be implemented.

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