Rate of EGFR mutation testing for patients with non-squamous non-small cell lung cancer with implementation of reflex testing by pathologists

  • P. K. Cheema Sunnybrook Odette Cancer Centre, University of Toronto
  • S. Raphael North York General Hospital
  • R. El-Maraghi Royal Victoria Regional Health Centre
  • J. Li Michael Garron Hospital
  • R. McClure Health Sciences North, Sudbury
  • L. Zibdawi Southlake Regional Health Centre
  • A. Chan Thunder Bay Regional Health Sciences Centre
  • J.C. Victor University of Toronto
  • A. Dolley AstraZeneca Canada Inc.
  • A. Dziarmaga AstraZeneca Canada Inc.
Keywords: Reflex testing, EGFR, biomarkers, non-small-cell lung cancer



Testing for mutation of the EGFR (epidermal growth factor receptor) gene is a standard of care for patients with advanced nonsquamous non-small-cell lung cancer (nsclc). To improve timely access to EGFR results, a few centres implemented reflex testing, defined as a request for EGFR testing by the pathologist at the time of a nonsquamous nsclc diagnosis. We evaluated the impact of reflex testing on EGFR testing rates.


A retrospective observational review of the Web-based AstraZeneca Canada EGFR Database from 1 April 2010 to 31 March 2014 found centres within Ontario that had requested EGFR testing through the database and that had implemented reflex testing (with at least 2 years’ worth of data, including the pre- and post-implementation period).


The 7 included centres had requested EGFR tests for 2214 patients. The proportion of pathologists requesting EGFR tests increased after implementation of reflex testing (53% vs. 4%); conversely, the proportion of medical oncologists requesting tests decreased (46% vs. 95%, p < 0.001). After implementation of reflex testing, the mean number of patients having EGFR testing per centre per month increased significantly [12.6 vs. 4.9 (range: 4.5–14.9), p < 0.001]. Before reflex testing, EGFR testing rates showed a significant monthly increase over time (1.37 more tests per month; 95% confidence interval: 1.19 to 1.55 tests; p < 0.001). That trend could not account for the observed increase with reflex testing, because an immediate increase in EGFR test requests was observed with the introduction of reflex testing (p = 0.003), and the overall trend was sustained throughout the post–reflex testing period (p < 0.001).


Reflex EGFR testing for patients with nonsquamous nsclc was successfully implemented at multiple centres and was associated with an increase in EGFR testing.

Author Biographies

P. K. Cheema, Sunnybrook Odette Cancer Centre, University of Toronto

Division of Medical Oncology and Hematology

S. Raphael, North York General Hospital

Department of Anatomic Pathology

R. El-Maraghi, Royal Victoria Regional Health Centre
Department of Medical Oncology/Hematology
J. Li, Michael Garron Hospital

Department of Medical Oncology/ Hematology

R. McClure, Health Sciences North, Sudbury

Department of Anatomic Pathology

L. Zibdawi, Southlake Regional Health Centre

Department of Medical Oncology/Hematology

A. Chan, Thunder Bay Regional Health Sciences Centre

Department of Medical Oncology/ Hematology

J.C. Victor, University of Toronto

Institute of Health Policy Management and

How to Cite
Cheema, P. K., Raphael, S., El-Maraghi, R., Li, J., McClure, R., Zibdawi, L., Chan, A., Victor, J., Dolley, A., & Dziarmaga, A. (2017). Rate of EGFR mutation testing for patients with non-squamous non-small cell lung cancer with implementation of reflex testing by pathologists. Current Oncology, 24(1), 16-22. https://doi.org/10.3747/co.24.3266
Medical Oncology