WCLC Sept 2021 | The evolving treatment landscape for NSCLC with EGFR exon 20 insertion mutations
Alexander Spira, MD, PhD, FACP, Virginia Cancer Specialists, Fairfax, VA, comments on the recent approvals of amivantamab, a bispecific monoclonal antibody, and mobocertinib, a small molecule tyrosine kinase inhibitor (TKI), for the treatment of patients with EGFR exon 20 insertion-positive non-small cell lung cancer (NSCLC) after treatment with platinum-based chemotherapy. He explains that with differing side effects and routes of administration, it is currently unclear which of these drugs will be the preferred treatment option. Several studies are also now investigating whether these drugs can be used in the first-line setting, either alone or in combination with chemotherapy. This interview took place at the World Conference on Lung Cancer (WCLC) 2021.
Transcript (edited for clarity)
So the current landscape of treatment of non-small cell lung cancer with exon 20 mutations has changed dramatically over the last couple of months. We’ve had the approval in the United States, and hopefully elsewhere soon as well, of two drugs, one is amivantamab and the other is mobocertinib. Amivantamab is an intravenous infusion, mobocertinib is an oral TKI. And this is great, this really opens up a whole new world for these patients in the second round of treatment after chemotherapy...
So the current landscape of treatment of non-small cell lung cancer with exon 20 mutations has changed dramatically over the last couple of months. We’ve had the approval in the United States, and hopefully elsewhere soon as well, of two drugs, one is amivantamab and the other is mobocertinib. Amivantamab is an intravenous infusion, mobocertinib is an oral TKI. And this is great, this really opens up a whole new world for these patients in the second round of treatment after chemotherapy. The ultimate questions are multifold. Number one is which one is better, and we don’t have the answer to that. They both have different side effects and different ways of administration. Mobocertinib is oral, amivantamab is intravenous. Amivantamab had a slightly higher response rate. Mobocertinib has the ability to have oral dosing, so there’s an advantage there. And again, how to really use response rates in cross-trial comparisons, we don’t really know.
Both are options for patients. What we don’t know is one going to be good for patients after another? We don’t know the answer to that, and that remains to be determined, most likely with anecdotal experience first, rather than true clinical trial data. I think the ultimate question now is can you move these drugs up in the line of therapy? So now those studies are ongoing, looking at is it better to add these on or use them in lieu of with chemotherapy in the first-line setting? And that’s really the next questions that we have. There’s also some other drugs coming down the pike, which is great, but it’s going to be a rapidly evolving field.
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