Advanced NSCLC: Treatment From 261 Cases of Lung Adenocarcinoma in a Brazilian Public Health Service.

Background: Lung cancer is a worldwide health problem. Brazil is no different with over 31,000 new cases estimated in 2018 nationwide. Unfortunately the majority of cases are diagnosed in advanced stage. Molecular testing for driver alterations, such as EGFR and ALK are mandatory as they are both prognostic and predictive biomarkers to recommend target therapy for metastatic disease. Many guidelines advocate to use a tyrosine kinase inhibitors (TKI) as first line therapy on advanced NSCLC (nonsmall cell lung cancer) based on increased PFS data compared with chemotherapy. In Brazil, molecular testing and target therapy for EGFR and ALK are not widely available in public health system. Aim: We aimed to evaluate the prevalence of patients with advanced NSCLC tested for EGFR and/or ALK that who received target therapy in a public health hospital in southern Brazil. Methods: All patients with NSCLC adenocarcinoma stage IIIB-IV from January 2013 through March 2018 were included. Medical records were reviewed to evaluate for molecular testing and target treatment. Results: We found a total of 261 patients diagnosed with NSCLC (adenocarcinoma). Out of these, 102 patients were staged IIIB/IV or with relapsed disease. In 49/102 (48.4%) cases some molecular testing was performed; EGFR 36 (35.3%), mutEGFR: 9/36 (25%), unknown (UK): 8/36 (22.2%); ALK: 19 (18.6%), without transloc. (w-o): 6/19 (31.6%); wtransloc: 1/19 (5.3%); UK 3/19 (15.8%). Out of 102 patients, only nine (8.8%) were included in a clinical trial; 6/102 (5.9%) received a TKI outside of a clinical trial setting. Only 2/6 received TKI as first line treatment whether the remaining 4/6 received a TKI on second line or beyond. Conclusion: Only half of the patients with advanced NSCLC were tested for either EGFR or ALK. Of these patients, 25% tested positive for a mutation in EGFR and 5.3% were found to have an ALK-rearrangement. Only 6 received TKI. Both molecular testing and target therapy are restricted by the public healthcare system. We depend on clinical trials or the pharmaceutical industry support, in many cases, to test for and identify such patients with target therapies. Treatment of lung cancer in Brazil contradicts a number of guidelines, expert's recommendations and best clinical practice. Unfortunately, legal measures are expensive and deleterious to national financial sustainability, but in many cases represent the only form to guarantee access to a TKI treatment. We found many systematic problems (loss of some patient's data) as a result from cross-sectional study. This may contribute to small number of patients. However the challenge to offer better treatment of lung cancer patients in Brazil was not affected. [ABSTRACT FROM AUTHOR]