EGFR Testing Patterns and Detection of EGFR Exon 20 Insertions in the United States

Abstract

IntroductionEGFR exon 20 insertions (EGFRex20ins) are a diverse set of mutations in NSCLC that are refractory to tyrosine kinase inhibitors. We describe real-world EGFRex20ins detection patterns in patients with advanced NSCLC in the United States.MethodsData from 2011 to 2020 were extracted from the Flatiron Health electronic health record-derived deidentified database.ResultsAmong 67,281 patients with advanced NSCLC and at least two clinic visits, 66.8% were tested for EGFR mutations, of whom 13.9% tested positive. Of these, 4.9% had EGFRex20ins. The median time from NSCLC diagnosis to the first positive EGFRex20ins test result was 23 days, including 9 days of laboratory testing time. The EGFRex20ins were reported in 0.6% to 1.0% of all patients with advanced NSCLC and account for 3.9% to 5.3% of all EGFR mutations. During the study period, reverse transcription–polymerase chain reaction testing rates decreased whereas next-generation sequencing rates increased both in overall and among patients with tumors positive for EGFRex20ins. Tissue was the most common sample type used for EGFR and EGFRexon20ins detection (81.1% and 84.9%, respectively), whereas blood sampling for EGFRexon20ins detection increased from 0% (2011) to 37.2% (2020). For 23.7% of patients with EGFRex20ins, treatment was initiated before receiving the first positive EGFRex20ins test result, with therapies including immuno-oncology agents as the most common treatment type from 2017 to 2020.ConclusionsEGFR testing and detection of EGFRex20ins in patients with NSCLC have increased slightly over time with the increasing use of next-generation sequencing. The current late-stage development of EGFRex20ins-targeted therapy is driving a need for more efficient testing.

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