Patient response to use of tyrosine kinase inhibitors in lung cancer: a retrospective audit during funding changes.

BACKGROUND: The New Zealand Pharmaceutical Management Agency (PHARMAC) approved funding of erlotinib in October 2010 as second line therapy in all non-squamous non-small cell lung cancer after platinum-based chemotherapy with no requirement for epidermal growth factor (EGFR) mutation testing. Funding widened in August 2012 to include gefitinib as first line treatment for patients with a proven EGFR mutation. Then in January 2014, both tyrosine kinase inhibitors (TKIs) were approved for first line treatment, but only for disease with EGFR mutation.

AIM: To report the clinical experience with TKIs in a New Zealand tertiary referral centre over a period of funding change.

METHOD: Retrospective audit of all patients commenced on erlotinib from 1st October 2010 until 1st November 2011, and gefitinib from 1st August 2012 until 31st August 2013. Follow-up was two years for both groups.

RESULTS: Each group had 42 patients. Median Progression Free Survival was 76 days in the erlotinib group and 255 days in the gefitinib group. Twenty-eight percent of erlotinib patients had grade 3 adverse events with one treatment related death; fourteen percent of gefitinib patients had grade 3 adverse events. Dose reduction or treatment breaks were required in 12% in each group.

CONCLUSION: Response rate in these audits appear to reflect the change in funding criteria, with improved response rates likely to be associated with more targeted treatment.