1232P - Understanding the diagnostic and treatment landscape in EGFRm advanced non-small cell lung cancer (aNSCLC) patients with exon 20 insertion mutations (Ex20ins)

Background

While most EGFR mutations are tyrosine kinase inhibitor (TKI) sensitive, Ex20ins are generally resistant to TKI treatment, making this a challenging patient group to treat. This study examined the treatment patterns and diagnostic landscape of aNSCLC patients with Ex20ins.

Methods

Real-world data were drawn from the NSCLC Disease Specific Programme^TM, a point in time survey administered to 53 oncologists/pulmonologists who completed record forms for 312 Ex20ins patients from July-December 2020 in France, Germany, Italy, Spain and the UK. Of 36 physicians based in hospital settings, 53% spent majority of their time in academic settings; 47% in community/general hospitals.

Results

Mean (SD) age was 65.6 (9.6) years, 52% were male, 52% were ex-smokers and 85% were stage IV at aNSCLC diagnosis. Patients had been diagnosed with Ex20ins for a median of 6.4 months. Most common Ex20ins subtypes were D770-N771insX (9%) and H773-V774insX (6%); 32% had other subtypes and for 56%, subtype was unspecified. Most patients were diagnosed using PCR-based techniques; 23% were diagnosed using NGS. Physicians who did not test for Ex20ins at the same time as primary EGFR testing (n=25) reported subsequent Ex20ins test had been carried out due to lack of response to TKIs (60%) and high rate of disease progression (40%). Physician reported barriers to testing for Ex20ins included inadequate tissue (57%) and time delay in getting test results (25%); 27% reported no barriers. Median time from Ex20ins diagnosis to receipt of 1st line (1L) treatment was 0.4 months (n=224). 37/312 patients received 1L treatment prior to Ex20ins diagnosis for a median duration of 1 month. The most received 1L regimens were osimertinib (27%), afatinib (17%) and gefitinib (10%). Of 58 patients who received 2nd line (2L), the most received 2L regimens were osimertinib (26%), carboplatin combinations (26%) and best supportive care, docetaxel or erlotinib (7% each). Treatment durations were also explored.

Conclusions

aNSCLC Ex20ins patients are still treated by TKI therapies not specifically indicated for these patients. There is need for more novel and efficacious treatments to treat Ex20ins patients.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Adelphi Real World.

Funding

Janssen Pharmaceutica NV.

Disclosure

F. Nasirova: Financial Interests, Personal, Full or part-time Employment: Janssen Pharmaceutical Companies of Johnson & Johnson. J. Sermon: Financial Interests, Personal, Full or part-time Employment: Janssen Pharmaceutical Companies of Johnson & Johnson. B. Rodrigues: Financial Interests, Personal, Full or part-time Employment: Janssen Pharmaceutical Companies of Johnson & Johnson. J. Penton: Financial Interests, Personal, Full or part-time Employment: Janssen Pharmaceutical Companies of Johnson & Johnson. All other authors have declared no conflicts of interest.