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EGFR gene mutation testing is a co-dependent service and is required to determine eligibility for treatment with the TKI erlotinib in previously untreated patients with locally advanced or metastatic NSCLC. Erlotinib (TARCEVA®, Roche) comes in tablet form taken orally, and is available as erlotinib hydrochloride in doses of 25mg, 100mg and 150mg (DoHA 2011). The proposed course of erlotinib for patients with previously untreated locally advanced or metastatic NSCLC would be a dose of 150mg daily (Cataldo et al. 2011; Riccardi S 2011; Rosell et al. 2009) until there is further disease progression or until toxicity prevent further use. In contrast the EGFR gene mutation test would on average be required only once in a patient’s lifetime.
Should approval be given for MBS listing of EGFR gene mutation testing, it is likely that the utilisation of erlotinib would increase as a first-line therapy for NSCLC patients. At the same time, utilisation of standard platinum-based chemotherapy is likely to decrease for these patients, and the utilisation of erlotinib as a treatment after failure of chemotherapy is also likely to decrease.
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