Areas of Growth in the Management of EGFR-Mutated Lung Cancer

Liza C. Villaruz, MD, medical oncologist/hematologist at UPMC Hillman Cancer Center, discusses what research in the EGFR-positive lung cancer space has recently caught the attention of experts.

The outlook for patients with EGFR-positive lung cancer has improved significantly in recent years with advances in targeted therapy and immunotherapy. While a number of biomarkers for non–small cell lung cancer (NSCLC) have been established, including KRAS, ALK, ROS1, and RET, Villaruz, highlights updates in the management of NSCLC harboring EGFR mutations.

In smaller subsets of EGFR-mutant disease, such as the EGFR exon 20 insertions, amivantamab (Rybrevant) is FDA-approved, and showing promise in previously-treated patients with EGFR exon 20 insertion-positive tumors. Other EGFR inhibitors approved by the FDA include afatinib (Gilotrif), dacomitinib (Vizimpro), erlotinib (Tarceva), gefitinib (Iressa), and osimertinib (Tagrisso).

Clinical trials continue to evaluate new agents and combinations in this space, and Villaruz highlights that next steps will be figuring out the best ways to tailor the targeted therapies that are being utilized.

Transcription:

0:10 | In terms of EGFR-mutant disease, I think the greatest area of growth is within acquired resistance to osimertinib therapy and ways of attacking and treating that resistance. I think there are several different agents which have shown activity across numerous different resistance mechanisms, such as the bispecific monoclonal antibody, amivantamab. This has been combined with a third generation EGFR inhibitor, lazertinib [Leclaza], and it looks as though there could potentially be activity across several different resistance mechanisms in patients with acquired TKI resistance.

0:57 | In addition, there are some antibody-drug conjugates, like pertuzumab [Perjeta], which has fairly encouraging activity across a number of different resistance mechanisms. There's a lot out there, and it's encouraging. I think where we go from here is sort of figuring out how best to identify mechanisms of resistance and the best ways to tailor our targeted therapies, which are specific to the acquired resistance mechanism.