Targeted therapy in the treatment of lung cancer in Iceland 2010–2023

Authors

  • Stefanía Ásta Tryggvadóttir Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  • Guðlaugur V. Stefánsson Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  • Helgi Birgisson Icelandic Cancer Registry, Reykjavik, Iceland
  • Örvar Gunnarsson Department of Oncology, Landspitali – The National University Hospital of Iceland
  • Tómas Guðbjartsson Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Oncology, Landspitali – The National University Hospital of Iceland
  • Hrönn Harðardóttir Department of Oncology, Landspitali – The National University Hospital of Iceland
  • Bylgja Hilmarsdóttir Department of Oncology, Landspitali – The National University Hospital of Iceland; Molecular Pathology Unit; Department of Pathology https://orcid.org/0000-0001-8693-5541
  • Rósa B. Barkardóttir Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Molecular Pathology Unit; Department of Pathology; University of Iceland; BioMedical Center (BMC)
  • Sigurdis Haraldsdottir Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Oncology, Landspitali – The National University Hospital of Iceland https://orcid.org/0000-0002-5050-3699

DOI:

https://doi.org/10.2340/ao.v65.45118

Keywords:

Non-small cell lung cancer, Next-Generation Sequencing (NGS), Precision cancer medicine, EGFR-mutation, real-world data

Abstract

Background and purpose: Lung cancer is the third most common malignancy in Iceland and remains the leading cause of cancer-related mortality. Lung cancer may harbor driver mutations affecting the function of Epidermal growth factor receptor (EGFR), Anaplastic lymphoma kinase (ALK), ROS proto-oncogene 1 (ROS1), B-raf proto-oncogene (BRAF), RET proto-oncogene (RET), MET proto-oncogene (MET), and NTRK, which can influence the selection of targeted therapies and treatment outcomes. In Iceland, EGFR testing was initiated in 2005, and in 2016, multigene targeted panel became standard for tumor testing. The objective was to determine the uptake of testing and frequency of targeted mutations in lung cancer nationwide, the utilization of targeted therapies, and duration of such treatments.
Patients/material and methods: Data on lung cancer diagnoses and stage at diagnosis were obtained from the Icelandic Cancer Registry, and molecular testing results were retrieved from the Department of Pathology at Landspitali University Hospital. Treatment data and outcomes were obtained from a central prescription/death registry and chart reviews.
Results: From 2010 to 2023, 2,528 patients were diagnosed with lung cancer, and 25% underwent ­molecular tumor testing, with 90% of stage IV adenocarcinomas tested in 2023. During comprehensive molecular testing in 2016–2023, targeted mutations were detected in 19.3% of tested patients: EGFR 9.9%, BRAF 2.3%, MET 2.7%, HER2 1.2%, ALK 2.7%, ROS1 0.6%, and RET 0.2%. Among patients found to have targeted mutations (2010–2023), 61.2% received targeted therapy; 33.8% remained on therapy for ≥ 12 months, and 13.5% for ≥ 24 months.
Interpretation: The use of molecular testing has increased significantly in the last 20 years, and the ­adaptation of new targeted therapies has been rapid.

Downloads

Download data is not yet available.

References

Krabbameinsfélag Íslands. Yfirlitstölfræði – Heildartölfræði allra krabbameina. [Internet]. Reykjavík: Krabbameinsfélag Íslands; [cited 2025 Nov 24]. Available from: https://www.krabb.is/krabbamein/tolfraedi/krabbamein-og-gaedaskraning/heildartolfraedi-meina

Harðardóttir H, Jónsson S, Gunnarsson Ö, Hilmarsdóttir B, Ásmundsson J, Guðmundsdóttir I, et al. Advances in the diagnosis and treatment of lung cancer. Icelandic Med J. 2022;108(1):17–29.

https://doi.org/10.17992/lbl.2022.01.671 DOI: https://doi.org/10.17992/lbl.2022.01.671

Icelandic Government. Statistics on tobacco control. Reykjavík: Government of Iceland; [cited 2025 Oct 18]. Available from: https://island.is/tolfraedi-um-tobaksvarnir

Vestergaard HH, Christensen MR, Lassen UN. A systematic review of targeted agents for non-small cell lung cancer. Acta Oncol. 2018;57(2):176–86.

https://doi.org/10.1080/0284186X.2017.1404634 DOI: https://doi.org/10.1080/0284186X.2017.1404634

Tan AC, Tan DSW. Targeted therapies for lung cancer patients with oncogenic driver molecular alterations. J Clin Oncol. 2022;40(6):611–25.

https://doi.org/10.1200/JCO.21.01626 DOI: https://doi.org/10.1200/JCO.21.01626

Koban MU, Hartmann M, Amexis G, Franco P, Huggins L, Shah I, et al. Targeted therapies, novel antibodies, and immunotherapies in advanced non-small-cell lung cancer: clinical evidence and drug approval patterns. Clin Cancer Res. 2024;30(21):4822–33.

https://doi.org/10.1158/1078-0432.CCR-24-0741 DOI: https://doi.org/10.1158/1078-0432.CCR-24-0741

Illumina. Multi-site analytical validation of TruSight® Tumor 15 (TST15): determining robustness and concordance. [Internet]. San Diego, CA: Illumina; 2017 [cited 2025 Oct 18]. Available from: https://www.illumina.com/content/dam/illumina-marketing/documents/products/technotes/tst15-analytical-validations-whitepaper.pdf

Diels S. Comprehensive genomic profiling with TSO500 [Internet]. Montreal, QC: CellCarta; 2023 [cited 2025 Oct 18]. Available from: https://cellcarta.com/science-hub/genomic-profiling-with-tso500/

Archer Dx. FusionPlex® Lung v2: targeted NGS panel for lung cancer research [Internet]. Boulder, CO: Archer Dx; 2023 [cited 2025 Oct 18]. Available from: https://www.dlongwood.com/catalogo/en/fusionplex-lung-v2/

Integrated DNA Technologies. Archer™ VARIANT Plex™ Expanded Solid Tumor panel: targeted NGS panel for solid tumor research [Internet]. Coralville, IA: Integrated DNA Technologies; 2023 [cited 2025 Oct 18]. Available from: https://www.idtdna.com/pages/products/next-generation-sequencing/archer-ngs-assay-solutions/solid-tumor-research/archer-variantplex-expanded-solid-tumor-panel

Sigurdardóttir LG, Jónasson JG, Stefánsdóttir S, Jónsdóttir A, Ólafsdóttir GH, Ólafsdóttir EJ et al. Data quality at the Icelandic Cancer Registry: comparability, validity, timeliness and completeness. Acta Oncol. 2012;51(7):880–9.

https://doi.org/10.3109/0284186X.2012.698751. DOI: https://doi.org/10.3109/0284186X.2012.698751

Felip E, Gridelli C, Baas P, Rosell R, Stahel R; Panel Members. Metastatic non-small-cell lung cancer: consensus on pathology and molecular tests, first-line, second-line, and third-line therapy: 1st European Society for Medical Oncology (ESMO) Consensus Conference in Lung Cancer; Lugano 2010. Ann Oncol. 2011;22(7):1507–19.

https://doi.org/10.1093/annonc/mdr150 DOI: https://doi.org/10.1093/annonc/mdr150

Lindeman NI, Cagle PT, Beasley MB, Chitale DA, Dacic S, Giaccone G, et al. Molecular testing guideline for selection of lung cancer patients for EGFR and ALK tyrosine kinase inhibitors: guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology. J Thorac Oncol. 2013;8(7):823–59.

https://doi.org/10.1097/JTO.0b013e318290868f DOI: https://doi.org/10.1097/JTO.0b013e318290868f

Lindeman NI, Cagle PT, Aisner DL, Arcila ME, Beasley MB, Bernicker EH, et al. Updated molecular testing guideline for the selection of lung cancer patients for treatment with targeted tyrosine kinase inhibitors: guideline from the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. J Mol Diagn. 2018;20(2):129–59.

https://doi.org/10.1016/j.jmoldx.2017.11.004 DOI: https://doi.org/10.1016/j.jmoldx.2017.11.004

Melosky B, Kambartel K, Häntschel M, Bennetts M, Nickens DJ, Brinkmann J, et al. Worldwide prevalence of epidermal growth factor receptor mutations in non-small cell lung cancer: a meta-analysis. Mol Diagn Ther. 2022;26(1):7–18.

https://doi.org/10.1007/s40291-021-00563-1 DOI: https://doi.org/10.1007/s40291-021-00563-1

Shepherd FA, Rodrigues Pereira J, Ciuleanu T, Tan EH, Hirsh V, Thongprasert S, et al. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med. 2005;353(2):123–32.

https://doi.org/10.1056/NEJMoa050753 DOI: https://doi.org/10.1056/NEJMoa050753

Lynch TJ, Bell DW, Sordella R, Gurubhagavatula S, Okimoto RA, Brannigan BW, et al. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med. 2004;350(21):2129–39.

https://doi.org/10.1056/NEJMoa040938 DOI: https://doi.org/10.1056/NEJMoa040938

Wu YL, Tsuboi M, He J, John T, Grohe C, Majem M, et al. Osimertinib in resected EGFR-mutated non-small-cell lung cancer. N Engl J Med. 2020;383(18):1711–23.

https://doi.org/10.1056/NEJMoa2027071 DOI: https://doi.org/10.1056/NEJMoa2027071

Helland Å, Andersen KK, Myklebust TÅ, Johannesen TB, Aarøe J, Enerly E. EGFR-mutation testing and TKI treatment patterns in locally advanced and metastatic NSCLC in Norway – a nationwide retrospective cohort study. Cancer Treat Res Commun. 2022;33:100636.

https://doi.org/10.1016/j.ctarc.2022.100636 DOI: https://doi.org/10.1016/j.ctarc.2022.100636

Shaw AT, Kim DW, Nakagawa K, Seto T, Crinó L, Ahn MJ, et al. Crizotinib versus chemotherapy in advanced ALK-positive lung cancer. N Engl J Med. 2013;368(25):2385–94. DOI: https://doi.org/10.1056/NEJMoa1214886

https://doi.org/10.1056/NEJMoa1214886. Erratum in: N Engl J Med. 2015;373(16):1582.

https://doi.org/10.1056/NEJMx150036 DOI: https://doi.org/10.1056/NEJMx150036

Shaw AT, Riely GJ, Bang YJ, Kim DW, Camidge DR, Solomon BJ, et al. Crizotinib in ROS1-rearranged advanced non-small-cell lung cancer (NSCLC): updated results, including overall survival, from PROFILE 1001. Ann Oncol. 2019;30(7):1121–6.

https://doi.org/10.1093/annonc/mdz131 DOI: https://doi.org/10.1093/annonc/mdz131

de Langen AJ, Johnson ML, Mazieres J, Dingemans AC, Mountzios G, Pless M, et al. Sotorasib versus docetaxel for previously treated non-small-cell lung cancer with KRASG12C mutation: a randomised, open-label, phase 3 trial. Lancet. 2023;401(10378):733–46.

https://doi.org/10.1016/S0140-6736(23)00221-0 DOI: https://doi.org/10.1016/S0140-6736(23)00221-0

Ramalingam SS, Vansteenkiste J, Planchard D, Cho BC, Gray JE, Ohe Y, et al.; FLAURA Investigators. Overall survival with Osimertinib in untreated, EGFR-mutated advanced NSCLC. N Engl J Med. 2020;382(1):41–50.

https://doi.org/10.1056/NEJMoa1913662 DOI: https://doi.org/10.1056/NEJMoa1913662

Downloads

Additional Files

Published

2026-04-09

How to Cite

Tryggvadóttir, S. Ásta, Stefánsson, G. V., Birgisson, H., Gunnarsson, Örvar, Guðbjartsson, T., Harðardóttir, H., … Haraldsdottir, S. (2026). Targeted therapy in the treatment of lung cancer in Iceland 2010–2023. Acta Oncologica, 65, 261–267. https://doi.org/10.2340/ao.v65.45118

Issue

Vol. 65 (2026): Acta Oncologica

Section

Original article

Categories

License

Copyright (c) 2026 Stefanía Ásta Tryggvadóttir, Guðlaugur V. Stefánsson, Helgi Birgisson, Örvar Gunnarsson, Tómas Guðbjartsson, Hrönn Harðardóttir, Bylgja Hilmarsdóttir, Rósa B. Barkardóttir, Sigurdis Haraldsdottir

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.