Msac application 1173

Comparator

In the current treatment algorithm for locally advanced or metastatic NSCLC, there is no EGFR gene mutation testing for previously untreated patients. The comparator is therefore ‘no testing’. In the current scenario of ‘no testing’, platinum-based doublet chemotherapy (mostly carboplatin + gemcitabine) is usually the preferred treatment offered to all locally advanced and metastatic NSCLC patients as a first-line therapy. Under the proposed intervention, ‘EGFR gene mutation testing for erlotinib eligibility in previously untreated locally advanced and metastatic patients’ will provide the opportunity for using erlotinib as a first-line therapy to EGFR M+ patients. As EGFR gene mutation testing is being proposed as a co-dependent service, a useful comparison would be ‘EGFR gene mutation testing followed by erlotinib or chemotherapy’ versus ‘no testing and chemotherapy’ for first-line therapy in locally advanced or metastatic NSCLC.

As there is currently no MBS listing for EGFR gene mutation testing, the MBS item descriptor for the comparator cannot be stated.
A PBAC submission for gefitinib for the treatment of patients with previously untreated locally advanced or metastatic NSCLC harbouring activating EGFR gene mutations is expected to be submitted. Therefore, if listed, gefitinib could be considered a comparator to erlotinib in this patient population. In this case, the comparison is EGFR gene mutation testing plus erlotinib or chemotherapy versus EGFR gene mutation testing plus gefitinib or chemotherapy.