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Ruchir Raman
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P37 - Pathology - Biomarker Testing (ID 107)
- Event: WCLC 2020
- Type: Posters
- Track: Pathology, Molecular Pathology and Diagnostic Biomarkers
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P37.30 - Prevalence of Actionable Mutations among Indian Patients with Advanced Non-Small Cell Lung Cancer: A Systematic Review (ID 3628)
00:00 - 00:00 | Presenting Author(s): Ruchir Raman
- Abstract
Introduction
In this current era of precision oncology, substantial advancements in diagnostic techniques and targeted treatments have revolutionized the treatment paradigm for patients with advanced Non-Small Cell Lung Cancer (NSCLC). Previous studies have suggested that Indian NSCLC patients share the highest rates of actionable alterations in EGFR and ALK compared to NSCLC patients elsewhere, though no systematic review specifically among Indian patients has confirmed these findings. Furthermore, limited epidemiologic data is available regarding mutations in other genes associated with response to corresponding targeted agents in the Indian context. We sought to comprehensively review the published literature assessing the prevalence of actionable mutations among Indian patients with NSCLC.
Methods
A systematic review of three databases (PubMed, EMBASE and Cochrane Library) was conducted to evaluate studies published before August 2020. Studies that 1) reported the prevalence of actionable ALK, BRAF, EGFR, HER2, MET, NTRK, RET, and/or ROS1 alterations among Indian patients with NSCLC and/or adenocarcinoma, 2) were retrospective or prospective in nature, and 3) evaluated patients 18 years of age or older were selected. Studies were reviewed in detail to ensure that published prevalence rates from the same institutions representing identical datasets were reported only once in our data synthesis. Two authors initially screened titles and abstracts from the search results using Microsoft Excel. The full-text publications of selected abstracts were reviewed thereafter. Information such as study location, population information/hospital setting, precision testing methods, histology information, and mutational prevalence were abstracted. This systematic review was registered with PROSPERO.
Results
The systemic literature search yielded 490 records in the Indian context. After screening the titles and abstracts, 36 studies were selected for full-text analysis. Twenty-six studies were ultimately selected for inclusion. Of the 26 selected publications, 15 evaluated adenocarcinoma patients specifically and 21 evaluated all NSCLC patients. Actionable EGFR, ALK and ROS1 mutations were reported in 20, 12, and 2 studies, respectively. The ranges of EGFR mutations and ALK rearrangements were 15.4% - 89.0% and 4.8% - 11.5% in adenocarcinoma patients, respectively, and 11.9% - 51.8% and 4.1% - 21.4% in NSCLC patients, respectively. Ranges of other actionable mutations among Indian NSCLC patients were 3.5% - 4.1% for ROS1 and 1.5% - 3.5% for BRAF. Only one study, which evaluated rates of actionable mutations among NSCLC patients without EGFR mutations, identified a prevalence of 1.5% and 0.7% for HER2 and NTRK alterations, respectively. Of the 20 studies evaluating EGFR mutations, 17 were completed by polymerase chain reaction (PCR) and 1 by next-generation sequencing (NGS).
Conclusion
Rates of actionable EGFR and ALK alterations are high among Indian NSCLC patients, providing expansive opportunities to administer targeted treatments to those with advanced disease. The wide ranges in reported results suggests that further work is required to determine differences in mutational prevalence within varying regions in India. Given the large volume of Indian NSCLC patients, significant efforts are needed to confirm rates of alterations in genes other than EGFR and ALK. Ideally, with the growing availability of NGS, many of these alterations may be studied concurrently.
