Molecular testing, frequency of molecular alterations and targeted 1st-line treatment of patients with non-small cell lung carcinoma in Germany. Results from the prospective German Registry CRISP (AIO-TRK-0315)

Background Treatment in non-small cell lung cancer is quickly evolving and new agents make it to the routine practice at a rapid pace. It is of high interest to patients (pts), physicians and reimbursement institutions to investigate how outcomes from clinical trials translate into routine practice.

Methods The prospective, national clinical research platform CRISP recruits pts in currently 155 representative cancer centres in all therapeutic sectors in Germany. Up to 8000 pts will be recruited and followed until death or up to a maximum of 3 years, respectively. Data from 823 pts recruited by 89 centers by June 30th, 2017 was analysed regarding molecular testing and 1st-line targeted treatment regimens. An update with data cut June 30th, 2018 including at least 2.000 pts by 130 centers will be presented at the conference.

Results Median age was 67 years and 61% of pts were male. 12% of pts were never smokers. 79% of pts had non-squamous carcinoma (nsqc), 21% squamous carcinoma (sqc). Overall, 84% of pts received any type of testing at the start of treatment, 28% of pts were tested by next generation sequencing. In pts with nsqc (n = 653) molecular test rates for EGFR, ALK, and ROS-1 were 73%, 70%, and 53% respectively. In pts with sqc (n = 170) molecular test rates for EGFR, ALK, and ROS-1 were 23%, 21%, and 15%, respectively. Test rates for PD-L1 increased from 23% in 2016 to 48% in the first half of 2017.

For pts with nsqc for whom test results were available at time of analysis, an EGFR alteration was detected in 15% (n = 71), an ALK alteration in 8% (n = 37), and a ROS-1 alteration in 3% (n = 10) of pts. 24% (n = 65) of pts for whom PD-L1 tumour proportion score (TPS) results were available had a TPS ≥ 50%.

71% of pts with any EGFR alteration (n = 72) were treated with a protein kinase inhibitor (most frequently afatinib) in 1st-line, 43% of pts with any ALK alteration (n = 38) with crizotinib. These rates also include treatment of some pts with uncommon and nondrugable EGFR or ALK alterations. Further details will be presented. In 2017, 73% of pts with a PD-L1 TPS ≥ 50% were treated with pembrolizumab in 1st-line.

Conclusion CRISP presents current real life data from all treatment sectors in Germany. Pts are frequently tested for molecular alterations and more than half of the pts with molecular alterations can start 1st-line treatment with a targeted therapy.