The following article features coverage from the NCCN 2022 Annual Conference. Click here to read more of Cancer Therapy Advisor’s conference coverage.

Real-world data suggest that waiting for biomarker testing results before starting first-line treatment of stage IV EGFR-mutated metastatic non-small cell lung cancer (mNSCLC) may be more beneficial for patients.

The study showed that starting first-line treatment before testing results were available was associated with a lower likelihood of receiving EGFR tyrosine kinase inhibitors (TKIs), and patients who did not receive EGFR TKIs had a significantly higher risk of dying or needing subsequent treatment.

These findings were presented in a poster at the NCCN 2022 Annual Conference.

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The researchers noted that the long turnaround time for biomarker testing and the relatively poor prognosis of stage IV mNSCLC may lead to patients starting non-targeted therapies before testing results are available. However, this approach could result in suboptimal outcomes.

The researchers studied 758 patients with stage IV EGFR-mutated, mNSCLC from the Flatiron Health Electronic Health Record Database. Patients were treated between May 2017 and December 2019.

Most patients (87.3%) received EGFR TKIs, 8.3% received immunotherapy with or without chemotherapy, and 4.4% received chemotherapy alone.

Starting treatment before EGFR testing results were available was more common among patients receiving immuno/chemotherapy (61.9%) or chemotherapy alone (60.6%) than among patients receiving EGFR TKIs (9.4%).

The median time to next treatment or death was significantly longer for patients treated with EGFR TKIs (14.8 months) than for patients treated with immuno/chemotherapy (3.7 months; P <.001) or chemotherapy alone (4.4 months; P <.001).

Patients treated with EGFR TKIs were significantly less likely to start second-line therapy or die, compared with patients on immuno/chemotherapy (hazard ratio, 0.33; P <.001) or chemotherapy (hazard ratio, 0.34; P <.001).

The researchers noted that this study may have been limited by the possibility that the treating physician knew the biomarker test results before they were recorded in the electronic medical record.

“This may help to explain why approximately 9% of patients on EGFR TKIs initiated before test results were available in the … record,” the researchers wrote.

Disclosures: Some study authors are employed by AstraZeneca. Please see the original reference for a full list of disclosures.

Read more of Cancer Therapy Advisor’s coverage of NCCN 2022 by visiting the conference page.


Apple J, Shenolikar R, De Silva K, et al. Real-world outcomes among patients with stage iv epidermal growth factor receptor (EGFR) mutated non-small cell lung cancer treated with EGFR tyrosine kinase inhibitors versus immunotherapy with or without chemotherapy in first-line setting. Presented at NCCN 2022 Annual Conference; March 31 – April 2, 2022. Abstract HSR22-124.