2023 World Conference on Lung Cancer (Posters)-EP06.03. Characteristics, Treatment Patterns and Outcomes of Real-World NSCLC Exon 20 Insertions in HER1 (EGFR) and HER2 (ERBB2)

EP06.03. Characteristics, Treatment Patterns and Outcomes of Real-World NSCLC Exon 20 Insertions in HER1 (EGFR) and HER2 (ERBB2) - PDF(Abstract)

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This study examines the characteristics, treatment patterns, and outcomes of patients with non-small cell lung cancer (NSCLC) and exon 20 insertions in HER1 (EGFR) and HER2 (ERBB2). These insertions occur in 3-4% of NSCLC cases and pose a challenge for clinical management due to their decreased sensitivity to conventional EGFR tyrosine kinase inhibitors (EGFR-TKI) and HER2 targeting antibody-drug conjugates. As targeted therapies for exon 20 insertions are not standard of care in Canada, the study aims to review real-world data on clinicopathological characteristics, treatment, response, and outcomes of these patients.<br /><br />The study reviewed data from the Glans-Look Lung Cancer Research Database, a province-wide registry of patients treated in routine practice. A total of 38 patients with EGFR (n=19) or ERBB2 (n=19) exon 20 insertions were identified. The majority of the cohort developed advanced/metastatic disease, and 63% received systemic therapy. Different systemic management strategies were observed in the first-line setting, with EGFR-exon20ins primarily receiving cytotoxic chemotherapy and ERBB2-exon20ins being managed as wildtype-NSCLC with treatment aligned to PD-L1 status.<br /><br />Despite the differing treatment modalities, there were no significant differences in treatment duration, response rates, primary resistance, or overall survival between EGFR-exon20ins and ERBB2-exon20ins. However, ICI-based therapies demonstrated good disease control, while EGFR-TKI appeared ineffective for both types of insertions.<br /><br />The study concludes that conventional EGFR-TKI is ineffective for both EGFR-exon20ins and ERBB2-exon20ins, while ICI-based therapy may be effective for ERBB2-exon20ins with PD-L1 TPS ≥50%. The findings highlight the need for future prospective studies to further evaluate the benefits and risks of ICI-based therapies in this patient population, which also has increasing access to novel targeted therapies.

Asset Subtitle

Amanda Gibson

Meta Tag

Speaker Amanda Gibson

Topic Pathology & Biomarkers: Genetic Biomarkers

Keywords

non-small cell lung cancer

NSCLC

exon 20 insertions

EGFR

HER2

conventional EGFR-TKI

HER2 targeting ADCs

clinicopathological characteristics

ICI-based therapies

prospective studies