Dr Qin on Choosing Between Targetable Agents in EGFR Exon 20–Mutated Lung Cancer

Angel Qin, MD, clinical assistant professor, Medical Oncology, Internal Medicine, Rogel Cancer Center, University of Michigan Health, discusses her process when choosing between targetable agents for patients with EGFR exon 20–mutated lung cancer.

At an OncLive® State of the Science Summit™, Qin and colleagues from Rogel Cancer Center each gave presentations on topics spanning lung cancer treatment. Qin presented information about targeting EGFRexon 20 in lung cancer, highlighting the use of both amivantamab-vmjw (Rybrevant) and mobocertinib (Exkivity). The superiority of 1 of these agents above the other is currently unknown, she emphasizes.

Amivantamab was approved by the FDA in May 2021 as the first approved treatment for adult patients with non–small cell lung cancer (NSCLC) whose disease harbors an EGFR exon 20 insertion mutation. This approval was supported by findings from the phase 1 multicenter, non-randomized, open label, multicohort CHRYSALIS trial (NCT02609776). Mobocertinib was approved by the FDA in September 2021 for the treatment of adult patients with locally advanced or metastatic NSCLC with EGFR exon 20 insertion mutations whose disease has progressed on or after platinum-based chemotherapy. This regulatory decision was supported by the results of a phase 1/2 trial (NCT02716116).

Qin emphasizes that the decision between amivantamab and mobocertinib should be made following a discussion with the patient. Treatment aspects to consider include whether the patient would prefer intravenous infusions vs a pill, as well as the adverse effect (AE) profile of each agent, Qin explains. There are specific AEs associated with each targeted agent, including more rash and infusion reactions with amivantamab vs more diarrhea with mobocertinib, she notes.

Although patient preferences and AEs are important considerations, oncologists still do not have appropriate data to support the use of 1 agent instead of the other in patients who had either prior chemotherapy or prior chemoimmunotherapy in the frontline setting, Qin continues. However, Qin believes it remains important to understand the toxicities that patients may have experienced with their prior treatments, as these may influence the decision to choose amivantamab or mobocertinib, Qin concludes.