Abstract
Purpose
Epidermal growth factor receptor (EGFR) exon 20 insertions (ex20ins) are associated with poor prognosis and resistance to traditional therapies in patients with non–small cell lung cancer (NSCLC). We aimed to elucidate the characteristics and treatment patterns to improve outcomes among this population in Taiwan.
Methods
Patients with advanced or recurrent NSCLC harboring EGFR ex20ins from 2011 to 2021 were reviewed. The treatment groups were classified as platinum-based chemotherapy (PtC), EGFR tyrosine kinase inhibitor (TKI), and others. The response to therapy, objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), and factors associated with survival were analyzed.
Results
Among the 71 patients, most were never-smoking males with stage IVB adenocarcinoma. The most common first-line (1L) regimen was PtC, followed by TKI. The most common second-line (2L) regimen was TKI. The median PFS of 1L treatment was 5.03 months, and the median OS was 18.43 months. Compared with that of TKI, 1L PtC use was associated with a higher ORR (26.3% vs. 9.1%) and DCR (60.5% vs. 18.2%) and a longer PFS (5.37 vs. 3.13 months, p = 0.044). PFS was also significantly longer in the 2L PtC group than in the 2L TKI group (4.73 vs. 2.25 months, p = 0.047). No patients receiving an immune checkpoint inhibitor–based regimen exhibited a therapeutic response.
Conclusion
This study demonstrated the heterogeneous clinical characteristics and treatment pattern of NSCLC patients with EGFR ex20ins, underscoring the need for more effective therapies for this distinct molecular subtype.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Funding
This study was supported by Taipei Veterans General Hospital, Taiwan. (Project number: V112A-001).
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Study conception and design: YTL and CLC. Material preparation, data collection and analysis were performed by YTL, RLS, CLC, HCH, CIS, YHT, THH, HSC, YHL. The PCR and NGS database were collected, reviewed, and summarized by LCW and YCY. All authors read and approved the final manuscript.
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CLC had received honoraria from AstraZeneca, Boehringer Ingelheim, Pfizer, and Roche. CIS had received honoraria from Boehringer Ingelheim and Pfizer. YHL had received honoraria from AstraZeneca, Boehringer Ingelheim, and Pfizer. YMC had received honoraria from Boehringer Ingelheim, Eli Lilly, Roche/Genentech/Chugai, MSD, Pfizer, Novartis, BMS, Ono Pharmaceutical, AstraZeneca, and Takeda Oncology; and served as an advisor for Boehringer Ingelheim, Eli Lilly, Roche/Chugai, MSD, AstraZeneca, and Takeda Oncology.
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This study was approved by the Institutional Review Board of Taipei Veterans General Hospital, Taiwan. (Approval number: 2022-07-028CC).
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Liao, YT., Wang, LC., Sun, RL. et al. Characteristics, treatment patterns, and clinical outcomes in patients with advanced non-small cell lung cancer harboring EGFR exon 20 insertions. J Cancer Res Clin Oncol 149, 10365–10376 (2023). https://doi.org/10.1007/s00432-023-04921-w
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DOI: https://doi.org/10.1007/s00432-023-04921-w