DETERMINANTS OF DELAY IN EGFR INHIBITOR INITIATION AND ITS IMPACT ON CLINICAL OUTCOMES IN NON-SMALL CELL LUNG CANCER PATIENTS
Author(s)
Zhanghe Chen1, Xiaomo (Shawn) Xiong, MS, PhD2;
1University of Cincinnati, Research Assistant, Cincinnati, OH, USA, 2James L Winkle College of Pharmacy, University of Cincinnati, Blue Ash, OH, USA
1University of Cincinnati, Research Assistant, Cincinnati, OH, USA, 2James L Winkle College of Pharmacy, University of Cincinnati, Blue Ash, OH, USA
OBJECTIVES: Delayed epidermal growth factor receptor (EGFR) treatment following testing could worsen symptoms among patients with advanced non-small cell lung cancer (NSCLC), yet determinants that contribute to the delay remain incompletely understood. This study aimed to identify determinants influencing EGFR testing-to-treatment delay.
METHODS: A retrospective cohort study was conducted using the TriNetX dataset from 2013 to 2025. The study population included adults diagnosed with NSCLC who received EGFR tyrosine kinase inhibitor (TKI) therapy. EGFR testing-to-treatment time was defined as the interval between the first EGFR test and the first EGFR TKI prescription and was categorized as early initiation (≤21 days) and delayed initiation (>21 days). Chi-sq tests and multivariable logistic regression were used to identify potential determinants including age, sex, race/ethnicity, testing methods, comorbidities, and co-medications, with odds ratios (ORs) and 95% confidence intervals (CIs) reported.
RESULTS: A total of 2,487 adults with NSCLC who received EGFR TKI therapy were included in the analysis. In the multivariable logistic regression, patients with unknown ethnicity were more likely to have delayed EGFR-TKI initiation compared to non-Hispanic patients (OR: 1.41, 95% CI: 1.04-1.92). In addition, patients with chronic obstructive pulmonary disease (OR: 1.30, 95% CI: 1.05-1.63) and those receiving cardiovascular system drugs (OR: 1.37, 95% CI: 1.07-1.75), genitourinary and sex hormone agents (OR: 1.40, 95% CI: 1.12-1.73), or antineoplastic and immunomodulating agents (OR: 1.72, 95% CI: 1.26-2.37) were more likely to experience delayed initiation.
CONCLUSIONS: Delays in EGFR-TKI initiation were associated with patient ethnicity reporting, comorbid COPD, and concurrent medication use. Clinically, these findings demonstrate the need for targeted care coordination and streamlined diagnostic-to-treatment pathways. Early identification of high-risk patients may facilitate timely therapy, potentially improving symptom control and clinical outcomes in patients with NSCLC.
METHODS: A retrospective cohort study was conducted using the TriNetX dataset from 2013 to 2025. The study population included adults diagnosed with NSCLC who received EGFR tyrosine kinase inhibitor (TKI) therapy. EGFR testing-to-treatment time was defined as the interval between the first EGFR test and the first EGFR TKI prescription and was categorized as early initiation (≤21 days) and delayed initiation (>21 days). Chi-sq tests and multivariable logistic regression were used to identify potential determinants including age, sex, race/ethnicity, testing methods, comorbidities, and co-medications, with odds ratios (ORs) and 95% confidence intervals (CIs) reported.
RESULTS: A total of 2,487 adults with NSCLC who received EGFR TKI therapy were included in the analysis. In the multivariable logistic regression, patients with unknown ethnicity were more likely to have delayed EGFR-TKI initiation compared to non-Hispanic patients (OR: 1.41, 95% CI: 1.04-1.92). In addition, patients with chronic obstructive pulmonary disease (OR: 1.30, 95% CI: 1.05-1.63) and those receiving cardiovascular system drugs (OR: 1.37, 95% CI: 1.07-1.75), genitourinary and sex hormone agents (OR: 1.40, 95% CI: 1.12-1.73), or antineoplastic and immunomodulating agents (OR: 1.72, 95% CI: 1.26-2.37) were more likely to experience delayed initiation.
CONCLUSIONS: Delays in EGFR-TKI initiation were associated with patient ethnicity reporting, comorbid COPD, and concurrent medication use. Clinically, these findings demonstrate the need for targeted care coordination and streamlined diagnostic-to-treatment pathways. Early identification of high-risk patients may facilitate timely therapy, potentially improving symptom control and clinical outcomes in patients with NSCLC.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD127
Topic
Real World Data & Information Systems
Topic Subcategory
Distributed Data & Research Networks
Disease
SDC: Oncology