How do you sequence targeted therapy and immunotherapy in patients with metastatic lung adenocarcinoma with EGFR exon 20 insertion mutations?

EGFR insertion 20 mutations are a rare subset of adenocarcinoma (1-2%). Patients with disease characterized by these mutations do not respond to EGFR TKIs such as osimertinib. Until recently, the standard first-line therapy for such patients was chemotherapy alone, typically carboplatin/pemetrexed. ...

For NSCLC with EGFR exon 20 insertion mutations, I tend to start with an amivantamab and chemotherapy combination as first-line treatment. Amivantamab is an EGFR/MET bispecific with activity against this particular disease subtype as studied in the PAPILLON phase III trial. Amivantamab presents its ...

For metastatic lung adenocarcinoma with an EGFR exon 20 insertion, targeted therapy is prioritized before immunotherapy. First-line treatment typically involves the targeted antibody amivantamab with platinum-based chemotherapy. Immunotherapy is generally less effective for patients with EGFR mutati...

Exon 20 insertion mutations do not respond well to osimertinib or the first- and second-generation EGFR tyrosine kinase inhibitors (e.g., erlotinib, afatanib). Until 2023, the standard of care for the treatment of patients with disease characterized by EGFR insertion 20 mutations was chemotherapy, u...