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Dissolving Knowledge Gaps Regarding EGFR Exon 20 Insertion–Mutant NSCLC

An educational enduring activity and podcast provided by i3 Health has demonstrated knowledge gains and learning outcomes regarding new perspectives on diagnosis and treatment of epidermal growth factor receptor (EGFR) exon 20 insertion–mutant non–small cell lung cancer (NSCLC).

Lung cancer is the second most common cancer in the United States, with 84% of lung cancers being classified as NSCLC. According to the American Cancer Society, in 2022 there are an estimated 236,740 new cases of lung cancer in the United States, with 130,180 of these cases expected to be fatal. The most frequent genomic variation among patients with NSCLC is the EGFR mutation, approximately 2% to 10% of which are exon 20 insertion mutations. These mutations are a heterogenous group often connected with a resistance to first- and second-line EGFR tyrosine kinase inhibitor therapy. Despite the recent approval of two new therapies designed to treat EGFR exon 20 insertion–mutant NSCLC, there remains an unmet need to develop effective therapeutic strategies to improve outcomes and quality of life in patients with this disease.

To address the knowledge gaps regarding the treatment of individuals with EGFR exon 20 insertion–mutant NSCLC, i3 Health provided an online continuing medical education (CME)– and nursing continuing professional development (NCPD)–approved podcast and video viewpoint strategy session from May 14, 2021, until May 13, 2022. The activity, New Perspectives on Diagnosis and Treatment of EGFR Exon 20 Insertion–Mutant NSCLC, was led by Helena Yu, MD, Assistant Attending Physician at Memorial Sloan Kettering Cancer Center, and Maria Arcila, MD, Director of the Diagnostic Molecular Pathology Laboratory at Memorial Sloan Kettering Cancer Center. This activity was supported by an educational grant from Millennium Pharmaceuticals, Inc.

The total number of learners who participated in the activity was 1,553, with 221 moving on to complete the activity for credit. Most learners were registered nurses (84%), followed by physicians (7%), nurse practitioners (4%), pharmacists (2%), advanced practice nurses (1%), clinical nurse specialists (1%), and physician assistants (1%). Attendees had been in their practice for an average of 16.5 years and saw an average of 13 patients with NSCLC per month.

The baseline data collected revealed knowledge gaps in the following areas: discussing the predictive/prognostic significance of EGFR exon 20 insertions in NSCLC, evaluating the benefits and limitations of polymerase chain reaction and next-generation sequencing in diagnosis of EGFR exon 20 insertion–mutant NSCLC, and assessing emerging efficacy and safety data on novel targeted therapies for advanced EGFR exon 20 insertion–mutant NSCLC. Participants were given an identical pretest and posttest to evaluate knowledge gained throughout the activity.

Prior to the start of the activity, the pretest scores revealed that 68% of participants were successful when identifying cisplatin/pemetrexed/pembrolizumab as the appropriate first-line treatment for a patient with newly diagnosed EGFR exon 20 insertion–mutant NSCLC and a programmed death ligand 1 (PD-L1) expression of 25%; 35% were successful when recognizing that next-generation sequencing (NGS) is the most comprehensive type of assay for detecting mutations such as EGFR exon 20 insertion mutations in NSCLC; and only 19% successfully identified mobocertinib as the appropriate treatment for a patient with metastatic NSCLC who recently relapsed and was identified to have an EGFR exon 20 insertion mutation.

Significant learning took place with knowledge gaps being addressed and closed during the activity, as revealed in the posttest data: 26% more learners were successful in identifying the appropriate first-line treatment of NSCLC; 38% more learners understood the use of NGS to detect EGFR exon 20 insertion mutations in NSCLC; and 54% more learners were successful in identifying the appropriate treatment for relapsed metastatic NSCLC with an EGFR exon 20 insertion mutation.

Upon completion of the activity, 82% of participants said they felt more confident in treating their patients with NSCLC, and 85% said that they felt the material provided would be used to improve the outcomes of their patients.

The data revealed by the posttest assessment affirm the effectiveness of the educational content and show significant gains in knowledge and proficiency regarding new perspectives on diagnosis and treatment of EGFR exon 20 insertion–mutant NSCLC. i3 Health has determined that the multidisciplinary team may benefit from CME/NCPD activities that provide education on therapeutic implications of EGFR exon 20 insertion–mutant NSCLC, efficacy of targeted therapies for EGFR exon 20 insertion–mutant NSCLC, and the management of adverse events associated with novel targeted therapies.

Resources

i3 Health (2022). New Perspectives on Diagnosis and Treatment of EGFR Exon 20 Insertion–Mutant NSCLC: activity outcomes report. Data on file.

American Cancer Society (2022). Lung cancer statistics. Available at: https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html


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