Reflex Testing | Biomarker Testing | Tagrisso (osimertinib)

Reflex testing is defined as ordering a standard group of pre-approved biomarker tests at the time of initial cancer diagnosis. Epidermal growth factor receptor mutations (EGFRm) are included in reflex testing bundles as standard in non- small cell lung cancer (NSCLC).¹ The benefits of a reflex testing approach screening all tumours independent of staging (compared to bespoke testing) include:^1–3

Increased numbers of patients tested for EGFRm

Streamlined pathology workload

A reduction in test turnaround time

Reflex testing is the preferred testing algorithm of The National Optimal Lung Cancer Pathway (NOLCP).⁴ Click the video to hear Professor John Gosney’s views on reflex testing.

Could your patients benefit from reflex testing?
Reach out to the AstraZeneca Diagnostics Team if you would like to discuss EGFR testing strategies in more detail contact us here.

References

Anand K, Phung TL, Bernicker EH, Cagle PT, Olsen RJ, Thomas JS. Clinical Utility of Reflex Ordered Testing for Molecular Biomarkers in Lung Adenocarcinoma. Clin Lung Cancer. 2020;21(5):437–442.
Gregg JP, Li T, Yoneda KY. Molecular testing strategies in non-small cell lung cancer: optimizing the diagnostic journey. Transl Lung Cancer Res. 2019;8(3):286–301.
Mok T, Carbone DP, Hirsch FR. IASLC Atlas of EGFR Testing in Lung Cancer – Guidebook. Editorial Rx Press, North Fort Myers, FL, U.S.A.; 2017. Available from: https://www.iaslc.org/
research-education/publications-resources-guidelines/iaslc-atlas-egfr-testing-lung-cancer-guidebook (last accessed January 2025).
NHS England. National optimal lung pathway. version 4.0, updated 2024. Available at: https://www.cancerresearchuk.org/sites/default/files/national-optimal-lung-cancer-pathway_v4_01jan2024.pdf (last accessed January 2025)

Adverse reactions reported	TAGRISSO		TAGRISSO with pemetrexed and platinum-based chemotherapy
Adverse reactions reported	CIOMS descriptor/ overall frequency (all CTCAE grades)	Frequency of CTCAE grade 3 or higher	CIOMS descriptor/ overall frequency (all CTCAE grades)	Frequency of CTCAE grade 3 or higher
Blood and lymphatic system disorders
Aplastic anaemia	Rare (0.06%)	0.06%	0%	0%
Leukopenia	Common (5.4%)	0.4%	Very common (12.7%)	2.9%
Lymphopenia	Common (1.7%)	0.2%	Common (2.5%)	1.1%
Thrombocytopenia	Common (7.6%)	0.6%	Very common (18.5%)	6.9%
Neutropenia	Common (6%)	0.9%	Very common (24.6%)	13.4%
Metabolism and nutrition disorders
Decreased appetite	Very common (19%)	1.2%	Very common (31%)	2.9%
Eye disorders
Keratitis	Uncommon (0.6%)	0.06%	Uncommon (0.7%)	0%
Cardiac disorders
Cardiac failure	Uncommon (0.5%)	0.2%	Common (1.8%)	1.1%
Respiratory, thoracic and mediastinal disorders
Epistaxis	Common (6%)	0%	Common (7%)	0.4%
Interstitial lung disease	Common (4.0%)	1.4%	Common (3.3%)	0.7%
Gastrointestinal disorders
Diarrhoea	Very common (47%)	1.4%	Very common (43%)	2.9%
Stomatitis	Very common (24%)	0.4%	Very common (31%)	0.4%
Skin and subcutaneous tissue disorders
Rash	Very common (46%)	0.8%	Very common (49%)	2.5%
Paronychia	Very common (34%)	0.4%	Very common (27%)	0.7%
Dry skin	Very common (32%)	0.1%	Very common (24%)	0%
Pruritus	Very common (17%)	0.06%	Common (8%)	0%
Alopecia	Common (5%)	0%	Common (9%)	0%
Palmar-plantar erythrodysaesthesia syndrome	Common (2.1%)	0%	Common (5%)	0%
Urticaria	Common (1.9%)	0.1%	Common (1.4%)	0.4%
Skin hyperpigmentation	Common (1.0%)	0%	Common (2.5%)	0%
Erythema multiforme	Uncommon (0.3%)	0%	Common (1.4%)	0.7%
Cutaneous vasculitis	Uncommon (0.2%)		0%	0%
Stevens-Johnson syndrome	Rare (0.02%)		0%	0%
Toxic Epidermal Necrolysis	Not known		0%	0%
Investigations
Left ventricular ejection fraction decreased	Common (4.2%)		Common (8%)
QTc interval prolongation	Common (1.1%)		Common (1.8%)
Blood creatine phosphokinase increased	Common (1.9%)	0.3%	Common (3.3%)	1.1%
Investigations (Findings based on test results presented as CTCAE grade shifts)
Leucocytes decreased	Very common (65%)	1.8%	Very common (88%)	20%
Lymphocytes decreased	Very common (64%)	8%	Very common (78%)	16%
Platelet count decreased	Very common (53%)	1.3%	Very common (85%)	16%
Neutrophils decreased	Very common (36%)	4.0%	Very common (85%)	36%
Blood creatinine increased	Common (9%)	0.2%	Very common (22%)	0.4%
Musculoskeletal and connective tissue disorders
Myositis	Uncommon (0.2%)	0%	0%	0%