Due to the harsh realities of the disease, the responsibility of sharing a cancer diagnosis can feel even harder if your patients with non-small cell lung cancer (NSCLC) have an EGFR exon 20 insertion (ex20ins) mutation[1][2][3][4][5]

Download our one-page summary on EGFR ex20ins mutations and how they impact patients.

Patients with EGFR ex20ins mutations have a poorer prognosis than those with other EGFR-TKI-sensitive mutations[1]

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]

Real world overall survival

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]

5 year survival rate

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]

Breaking a diagnosis of an EGFR ex20ins mutation can be made harder by the limitations of current treatments[1][2][3][4][5]


No oncologist, nurse, or other healthcare professional finds sharing a cancer diagnosis with a patient and their family easy – everyone wishes there was more they could do, or some hope to offer.[3][5]


Breaking the news that a patient has an EGFR exon 20 insertion mutation in their tumour can be even more difficult, as these patients have a poor prognosis and experience limited outcomes with currently approved targeted EGFR-TKIs.[1][2][3][4][5][6][7]

Find out how EGFR ex20ins mutations cause EGFR-TKI resistance.

Testing may help to avoid the prescription of ineffective therapies – and help your patients get the best possible outcomes[8][9]

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]

Real world progression

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]

Discover how NGS can help you find EGFR ex20ins mutations and help you fight them.

The precious time that patients have left may be tainted by the worry and burden of their disease[14]

In fact, a qualitative study that interviewed patients with EGFR exon 20-mutated NSCLC (90% of whom had ex20ins mutations) showed that:[14]

emotional impact

100% reported feeling a negative emotional or psychological impact


60% reported worry and anxiety about treatment, finances, or the future

Self Care

60% said it impacted self-care and household chores

negative impact on work

50% reported a negative impact on work

impacted family

40% said their disease impacted family

impacted social activities

50% said their disease impacted social activities

There is a significant need for therapies that are specifically engineered for EGFRm ex20ins NSCLC, which are more effective, tolerable, and targeted than currently available therapies.[1][2][15]

Discover more about EGFR exon 20 insertion mutations and NSCLC here:

Who do EGFR ex20ins mutations strike?
What causes EGFR-TKI resistance?
How can NGS help you to find EGFR ex20ins mutations?

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.