Zofia Piotrowska, MD reviews historical treatment approaches for patients with NSCLC and EGFR exon 20 insertions.
Mathew Fowler: Let’s look at these treatment options. What has been the past approach to treatment for patients with EGFR exon 20 insertions?
Dr. Zofia Piotrowska: We have long known that the common first and second generation EGFR inhibitors – Erlotinib, Gefitinib, and Afatinib – were ineffective for these patients. Third-generation EGFR inhibitors such as osimertinib have not yet been decided by the jury, but the data so far certainly seem to show that these drugs are not as effective as they are for exon 19 deletions and L858R point mutations. For a long time, lung cancers with an exon 20 insertion mutation were treated with standard chemotherapy and this remains a very good option for these patients. We are considering first-line carboplatin-pemetrexed chemotherapy for these patients. In practice, there is a debate about whether they should be treated with chemotherapy-immunotherapy combinations or whether immunotherapy is less beneficial for patients with EGFR exon 20 than for other types of EGFR Mutations. The jury disagreed on the role of immunotherapy, but chemotherapy certainly remains an important treatment option that it has been for these patients in the past.
Transcript edited for clarity.