Background: Patients with advanced EGFR-mutated NSCLC benefit from treatment with EGFR TKIs. However, gaps in oncologists' performance hamper their ability to integrate individualized treatments into the care of patients with this disease. This study was conducted to determine if an online, virtual patient simulation (VPS)-based continuing medical education (CME) intervention improved performance of oncologists in using appropriate strategies to diagnose and manage patients with advanced EGFR-mutated NSCLC.

Methods: The CME intervention consisted of two cases presented in a VPS platform that allowed learners to order lab tests, diagnoses and treatments in a manner matching the scope and depth of actual practice. Clinical decisions made by the learners using open field entries within an EHR interface were analyzed and, after each decision, tailored clinical guidance (CG) was provided based on current evidence and expert recommendation. Learner decisions were collected post-CG and compared with each user's baseline (pre-CG) data using a 2-tailed paired T-test to determine P values. The activity posted May 29, 2019; data were collected through October 15, 2019.

Results: Significant improvements (reported as absolute) were observed after CG in clinical decisions made by oncologists:

Clinical Decision% Absolute Improvement (% correct pre-CG vs % correct post-CG); P value
 Case 1 (N=178) 59 YO African American female recently diagnosed with lung cancer after 6-week history of fatigue, cough, dyspnea; nonsmoker with history of hypertension Case 2 (N=93) 51 YO male recently diagnosed with stage IV lung cancer with liver metastases after presenting with hacking cough, fatigue, and weight loss for the past 3 months; 10 pack-year history of smoking and hypertension 
Order PD-L1 expression 14% (69% vs 83%); P<.001 5% (79% vs 84%); P=.02 
Order brain MRI with/without contrast 21% (53% vs 74%); P<.001 11% (67% vs 78%); P=.001 
Order EGFR mutation test via tumor biopsy 6% (84% vs 90%); P<.001 5% (85% vs 90%); P=.02 
Diagnose stage IV, NSCLC, adenocarcinoma, EGFR del19 with multiple brain metastases 37% (26% vs 63%); P<.001 – 
Diagnose stage IVB, NSCLC, adenocarcinoma, EGFR del19 – 29% (41% vs 70%); P<.001 
Start first-line EGFR TKI 41% (45% vs 86%); P<.001 29% (54% vs 83%); P<.001 
Selection of osimertinib as first-line treatment 26% (37% vs 63%); P<.001 23% (49% vs 72%); P<.001 
Clinical Decision% Absolute Improvement (% correct pre-CG vs % correct post-CG); P value
 Case 1 (N=178) 59 YO African American female recently diagnosed with lung cancer after 6-week history of fatigue, cough, dyspnea; nonsmoker with history of hypertension Case 2 (N=93) 51 YO male recently diagnosed with stage IV lung cancer with liver metastases after presenting with hacking cough, fatigue, and weight loss for the past 3 months; 10 pack-year history of smoking and hypertension 
Order PD-L1 expression 14% (69% vs 83%); P<.001 5% (79% vs 84%); P=.02 
Order brain MRI with/without contrast 21% (53% vs 74%); P<.001 11% (67% vs 78%); P=.001 
Order EGFR mutation test via tumor biopsy 6% (84% vs 90%); P<.001 5% (85% vs 90%); P=.02 
Diagnose stage IV, NSCLC, adenocarcinoma, EGFR del19 with multiple brain metastases 37% (26% vs 63%); P<.001 – 
Diagnose stage IVB, NSCLC, adenocarcinoma, EGFR del19 – 29% (41% vs 70%); P<.001 
Start first-line EGFR TKI 41% (45% vs 86%); P<.001 29% (54% vs 83%); P<.001 
Selection of osimertinib as first-line treatment 26% (37% vs 63%); P<.001 23% (49% vs 72%); P<.001 

Conclusions: This study demonstrated that VPS that immerses and engages oncologists in an authentic and practical learning experience can significantly improve evidence-based clinical decisions related to diagnosis and management of patients with advanced EGFR-mutated NSCLC. Continued educational activities are needed to address the residual gaps in appropriate treatment and increase oncologists' confidence in this clinical setting.

Citation Format: Michelle A. Worst, Rich Caracio, Donna L. Topping, Suresh S. Ramalingam. Virtual patient simulation improves first-line treatment selection in advanced EGFR-mutated NSCLC [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2040.