- EGFR
- EGFR exon 20 insertion mutations
Patients with EGFRm ex20ins NSCLC have a median real-world overall survival (rwOS) of only 16.2 months (fig. 1).[1]
That represents a 75% increased risk of death (HR=1.75) compared to patients who have common EGFR-tyrosine kinase inhibitor (EGFR-TKI) sensitive mutations in their tumours* (median rwOS 25.5 months)[1]
Figure 1. Real-world overall survival (rwOS) of patients with EGFRm ex20ins NSCLC, as compared to those with common classical EGFR mutations (L858R and exon 19 deletions).[1]
Data from a retrospective cohort study including patients from the Flatiron Health database (01/01/2011–31/05/2020) who had advanced NSCLC.
Adapted from Girard N et al. 2021.[1]
Figure 2. 5-year survival rate of patients with EGFRm ex20ins NSCLC, as compared to patients with EGFR-TKI-sensitive mutations.*[1]
Adapted from Girard N et al. 2021.[1]
* EGFR exon 19 deletions and EGFR L858R point mutation.[1]
The ESMO, German Leitlinien Programm Onkologie, Italian Association of Medical Oncology (AIOM) guidelines and NCCN guidelines all recommend routine testing for EGFR ex20ins mutations – detection of these mutations can help to guide treatment.[8][9][10][11]
This can help you to avoid the prescription of ineffective EGFR-TKI therapies – ensuring patients receive the current standard of care (chemotherapy).[8][9]
Despite being non-selective, chemotherapy regimens provide a higher median overall response rate (mORR = 23–29%) than currently approved EGFR-TKIs (mORR 0–8.7%) in the first-line setting.**[12][13] Additionally, with a median overall survival of 17.4 months, and a median progression-free survival of 6.5 months in the first-line setting, chemotherapy offers a longer protection against progression or death, as compared to EGFR-TKIs or immuno-oncology agents (IO) (fig. 3).[1]
Figure 3. Real-world progression-free survival (rwPFS) and real-world overall survival (rwOS) of patients with EGFRm ex20ins NSCLC, by therapy, in the first- and second-line treatment setting.[1]
Adapted from Girard N et al. 2021.[1]
** The median ORR varied depending on the chemotherapy regimen or EGFR-TKI therapy given, with an ORR of: 29% in patients treated with pemetrexed-containing chemotherapy, 28.8% in patients treated with chemotherapy (unspecified), 23% in patients treated with platinum-based chemotherapy, 8.7% in patients treated with afatinib, 6.3% in patients treated with EGFR-TKIs (unspecified), and 0% in patients treated with erlotinib/gefitinib/osimertinib.[13]
In fact, a qualitative study that interviewed patients with EGFR exon 20-mutated NSCLC (90% of whom had ex20ins mutations) showed that:[14]
EGFR, epidermal growth factor receptor; EGFRm, mutated EGFR; ex20ins, exon 20 insertion mutations; EGFR-TKI, EGFR tyrosine kinase inhibitor; mPFS, median progression free survival; NGS, next-generation sequencing; NSCLC, non-small cell lung cancer; rwOS, real-world overall survival.
CP-223640