The proportion ofEGFR+NSCLC patients never treated with TKI – A single institution Croatian experience

Introduction: EGFR TKI-s are standard 1 st line treatment of advanced EGFR+ NSCLC patients in the developed world. According to the Croatian Health Insurance guidelines EGFR-TKIs are indicated in the 2 nd line treatment of these patients. Aims and objectives: According to relevant clinical studies only 50-60% of all patients receive any 2 nd -line treatment. A growing number of clinical studies indicate also that in the population of patients with advanced EGFR+ NSCLC selected for chemotherapy in 1 st line, one in five never receive EGFR-TKI despite planning of giving them in the later course of treatment. As Croatia remained the only European country without the approval of TKI EGFR in the 1 st line we were interested in proportion of our patients never treated with TKI. Methods: A retrospective analysis of the applied treatment of 89 advanced EGFR+ NSCLC patients treated in University hospital center Zagreb between July 2012 and October 2015 was done. Results: Among a total of 89 patients included, six patients received 1 st line TKI despite guidelines, 42 were treated with TKI in the 2 nd and 23 in the 3 rd line. The remaining 18 patients (20 %) have never received any TKI in any line during oncology treatment. Among them 11 patients received at least one cycle of cytostatic therapy, while other 7 received BSC due to comorbidities and poor condition. Conclusion: Results of our study are consistent with the results of leading clinical trials showing that only 80% of EGFR+ NSCLC patients receive TKI during oncological treatment and even one-fifth of patients never get EGFR TKIs despite the fact that they present a comparative advantage in relation to cytostatic chemotherapy.