Inequalities in lung cancer: a world of EGFR

Epidermal growth factor receptor gene (EGFR) mutation status has emerged as a crucial issue in lung cancer management. Availability and cost of tests and tyrosine kinase inhibitors (TKIs) may vary as a function of country development. We conducted a prospective specialist opinion survey to map EGFR test and EGFR-TKI availability and detect associations with the Human Development Index (HDI). A questionnaire was sent to specialists in thoracic oncology in all United Nations Member States. We obtained responses from 74 countries, comprising 78% of the worldwide population. Nonresponding countries had significantly lower HDI rank than responding countries. EGFR mutation analysis was routinely available in 57 countries (70% of the worldwide population). The cost of the test was <US$500 in 49 countries (42.5% of the worldwide population). Test availability and cost were both significantly linked to HDI. Erlotinib, gefitinib, afatinib and icotinib were routinely available in 75%, 66%, 31% and 23% of the worldwide population, respectively, also associated with HDI. EGFR mutation testing and EGFR-TKIs are widely accessible in routine practice worldwide. However, there are large discrepancies in access to this innovative treatment path and in its cost for patients as a function of country development.