Download Epidermal Growth Factor Receptor(EGFR) Mutation test for patients

Epidermal Growth Factor Receptor(EGFR) Mutation test
for patients with Non-small cell lung cancer (NSCLC)
[Adapted from the report by Dr.Ana Fizalinda Abdullah Sani]
Introduction
Review Group Membership
MaHTAS Reviewer:
Ku Nurhasni Ku Abd Rahim
Dr. Ana Fizalinda Abdullah Sani
Dr. Izzuna Mudla M.Ghazali
Datin Dr. Rugayah Bakri
External Reviewer:
Dr Jamallul Azizi A. Rahman
Dr Adlinda Alip
Disclaimer:
Technology review is a brief
report, prepared on an urgent
basis, which draws on restricted
reviews from analysis of pertinent
literature, on expert opinion and /
or
regulatory
status
where
appropriate. It is not subjected to
an external review process. While
effort has been made to do so, this
document may not fully reflect all
scientific
research
available.
Additionally,
other
relevant
scientific findings may have been
reported since completion of this
review.
For further
contact:
information
please
Health Technology Assessment
Section (MaHTAS)
Medical Development Division
Ministry of Health Malaysia
Level 4, Block E1, Precinct 1
Government Office Complex
62590 Putrajaya.
Tel: 603 8883 1246
Lung cancer has been identified as the most common cancer among males and
third most common cancer in the general population. Non-small-cell lung cancer
(NSCLC) is the most common form of lung cancer and has three main histological
subtypes which are squamous cell carcinoma, adenocarcinoma and large cell
carcinoma. There were 1,865 cases of lung cancer diagnosed in 2007 and
registered at NCR, comprising of 1,320 males and 545 females. The Agestandardised Rates (ASR) for male was 14.7 per 100,000 population and 5.6 per
100,000 population for female.
However, EGFR mutation test are not routinely performed in patients with nonsmall-cell lung cancer in most East Asian medical centers, hospital, or clinics.
Among the identified potential barriers to EGFR mutation testing in most East
Asian countries are the cost of the EGFR mutation test, challenges in the
specimen acquisition, availability of experience clinical pathologists for the required
tests and number of laboratories capable of performing the test in each country.
Objective/Aim
The objective of the technology review was to review the clinical effectiveness and
diagnostic performance of EGFR mutation testing to detect the presence of EGFR
mutations in patients with non-small cell lung cancer (NSCLC).
Results and Conclusions
There were two systematic review studies, one diagnostic study and 11
observational studies included in this review. In addition, there was one economic
evaluation study retrieved from the scientific databases.
Based on the above review, there were fair to good level of evidence that suggest
epidermal growth factor receptor (EGFR) mutation test contribute to the delivery of
personalised cancer treatment plans by identifying the suitable patients for
treatment with tyrosine kinase inhibitor with promising clinical effectiveness such
as better overall response, overall survival and progression-free survival. The
evidence suggested that EGFR mutations were detected more frequently in
women, non smokers and in patients with histology result of adenocarcinoma.
Fax: 603 8883 1230
Available at the following website:
http://www.moh.gov.my
2013
A variety of methods have demonstrated to be potential alternatives to the
historical standard for EGFR mutation testing, namely direct sequencing. However,
the only choice of the testing methods should based on local setting whether
detection of known activating EGFR mutations only or all possible mutations is
required, the availability of the equipment and laboratory’s expertise, availability of
sample and cost. In order to maximize the benefit of the EGFR mutation test for
local population, proper selections of patients need to be taken into consideration
as ethnicity, sex and smoking status were reported to be associated with EGFR
mutation.
Methods
Scientific electronic databases were searched through OVID interface which
include OVID MEDLINE (R) In process &Other Non-Indexed Citations and OVID
MEDLINE (R) 1946 to present, Cochrane Central Register of Controlled Trials
June 2013, Cochrane Database of Systematic Reviews 2005 to May 2013, EBM
Reviews- Database of Abstracts of Reviews of Effects 2nd Quarter 2013, EBM
Reviews- Health Technology Assessment 2nd Quarter 2013, EBM Reviews- NHS
Economic Evaluation Database 2nd Quarter 2013, EBM reviews-ACP journal
Executive Summary
Club1991-June 2013, EBM Reviews-Cochrane Methodology Register 3rd Quarter
2012, Embase and Pubmed.
Last search was done on 15th August 2013 and there was no limitation during the
search. Relevant articles were critically appraised using Critical Appraisal Skills
Programme (CASP) checklists. Evidence was graded according to the US /
Canadian Preventive Services Task Force and NHS Centre for Reviews and
Dissemination (CRD) University of York, Report Number 4 (2nd Edition).
Executive Summary