Treatment Outcomes of Non-Small Cell Lung Cancer Adenocarcinoma in Locally Advanced and Metastatic Stages Following EGFR Mutation Testing from Tissue or Plasma Samples
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Abstract
BACKGROUND: Lung cancer is a leading cause of mortality in Thailand. EGFR mutation testing plays a crucial role in guiding targeted therapy selection. However, prolonged turnaround times remain a barrier to timely treatment access.
OBJECTIVE: This study aimed to evaluate 1) Lean process optimization for EGFR mutation testing, 2) access to targeted therapy among lung cancer patients, and 3) treatment outcomes by comparing overall survival (OS) and progression-free survival (PFS) between mutation-positive and mutation-negative groups.
METHODS: This mixed-methods study was conducted in two phases. Phase one involved in-depth interviews with the head of the genomics laboratory staff, integrated with Lean process optimization to reduce testing turnaround times. Phase two comprised a retrospective analysis of lung cancer patients treated at the Prapokklao Cancer Center of Excellence, Prapokklao Hospital, between February 2021 and July 2022. EGFR mutation testing was performed on tissue and plasma samples. Patients were classified by mutation status, and OS and PFS were compared using the Kaplan–Meier method and Log-Rank test.
RESULTS: Lean implementation reduced turnaround times from 21 to 6.1 days for tissue and from 14 to 2 days for plasma. Among 203 patients (60.6% male; 39.4% Stage IIIB, 60.6% Stage IV), EGFR mutations were detected in 57 cases (28.1%), predominantly Ex19Del, L858R, and Ex20Ins. Female sex was significantly associated with mutation-positive status (p<0.001). Of the mutation-positive patients, 73.7% (42/57) accessed targeted therapy within a mean of 33 days. The mutation-positive group showed significantly longer median OS (531 vs. 183 days) and median PFS (149 vs. 98 days) compared with the mutation-negative group.
CONCLUSION: Lean optimization of EGFR mutation testing substantially reduced turnaround times, enabling faster access to targeted therapy and improved survival outcomes, offering a practical model for cancer care in public.
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