My name is Nora Chowdhury, and I'll be presenting the following abstract. Patients with EGFR Axon 20 insertions comprise 4 to 10 percent of EGFR mutant non-small cell lung cancer. Unlike patients with EGFR Axon 19 deletions or L858R, patients with EGFR Axon 20 insertions are generally insensitive to currently approved TKIs at standard doses. Although several investigational strategies are in development, our goal was to describe the clinical outcomes and response to standard therapies for patients with this uncommon genotype. We identified all patients with EGFR Axon 20 insertions that were identified via MSK IMPACT. We compared patient and tumor characteristics for patients with EGFR Axon 20 insertions compared to all other patients with non-small cell lung cancer who underwent IMPACT in the same timeframe. And we also compared treatment and survival outcomes to patients with non-small cell lung cancer without targetable alterations. In total, we identified 106 patients with EGFR Axon 20 insertions and compared to all other patients with non-small cell lung cancer, patients with EGFR Axon 20 insertions were younger, more frequently women, and Black or Asian. The majority had adenocarcinoma histology and lighter-nose smoking history. The distribution of EGFR Axon 20 insertions is shown here. We saw that compared to non-small cell lung cancer patients without targetable alterations, patients with EGFR Axon 20 insertions had prolonged overall survival of 20 versus 12 months. We included survival from the date of first-line metastatic treatment to date of death or sensor. We included only patients with metastatic disease, and left truncation was also applied. We saw that patients with EGFR Axon 20 insertions also had prolonged time-to-treatment discontinuation on platinum chemotherapy of seven versus four months. But we did also see that patients with EGFR Axon 20 insertions did not derive additional benefit from immune checkpoint inhibitor therapy. We also explored combination chemoimmunotherapy, but the results were not statistically significant, most likely due to small sample size. Finally, we showed that patients with EGFR Axon 20 insertions had a lower tumor mutational burden and a higher proportion of patients with PD-L1 expression less than 1% compared to all other non-small cell lung cancer patients, as well as specifically patients with EGFR deletion, Axon 19 deletion, or LA58R. Our study had several limitations shown here. In conclusion, we show that patients with EGFR Axon 20 insertions have distinct clinical characteristics and they also have prolonged survival compared to patients without targetable alterations and improved response to platinum chemotherapy, but suboptimal response to immune checkpoint inhibitors. We overall conclude that patients with EGFR Axon 20 insertions would benefit from the development of molecularly targeted therapies. Thank you for your attention.

EGFR Axon 20 insertions

non-small cell lung cancer

clinical outcomes

standard therapies

overall survival