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THREAD: I have heard a lot of self-righteous indignation about how we would be bankrupting the system with adjuvant targeted treatment for EGFR mutation+ NSCLC pts, so let's take a quick look at how many pts we're talking about here to put this in perspective. #ASCO20 #LCSM 1/8
There will be about 230,000 people diagnosed with lung cancer in the US in 2020, of which about 88% have NSCLC and 60% of those have adenocarcinoma (~121,000). About 15% of those have EGFR mutations, so the total # of EGFR mutation+ NSCLC cases in US in 2020 is about 18,000. 2/8
Of those 18,000 people, ~1/3 will be diagnosed at stage 4, about 1/3 will have stage 3, and about 1/3 will have resectable early stage (I or II). Stage 2 is the smallest section, at about 10% of the total, and most stage 3 is unresectable so perhaps another 10% get surgery. 3/8
So ~20% of the 18,000 people with EGFR mutant NSCLC will be in the group eligible for adjuvant treatment, or about 3600 people per year. If we go conservative and expand to 30% that makes 5400. Compare this to the 60,000 pts with stage 3 NSCLC who are eligible for durvalumab 4/8
The 5400 patients eligible for adjuvant osimertinib also are substantially fewer than the number of stage 4 patients who will get pembrolizumab +/- chemo (~60,000) and even EGFR mutation+ stage 4 pts who get osimertinib anyway at SOC (~6000). 5/8
Also keep in mind that in the absence of adjuvant treatment (control arm of ADAURA), only 28% of these pts were still disease free at 3 years, meaning 72% at least of the patients would still go on to osimertinib for recurrent cancer anyway so this is only a shift in timing. 6/8
We should also start thinking about consolidation osimertinib for stage 3 EGFR mutant NSCLC after chemorads, if LAURA trial is positive (seems likely after ADAURA), which adds another ~6000 pts per year who need osi. Still pales compared to nontargeted tx (again ~60,000). 7/8
