How would you approach treatment of a patient with metastatic NSCLC with PD-L1>1% and HER2-mutation?

Does this change for PDL1 1-49% vs >50%? Will you be more likely to employ other checkpoint inhibitors before use of HER2 targeting therapy? Or start with targeted therapy and reserve checkpoint inhibitors for later lines?

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How will you factor in HER2 mutation status to treatment decisions in PDL+ NSCLC?

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3 Answers

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Medical Oncology · University of Nebraska Medical Center

Answered on

No, I do not believe that this changes anything for that population. The immunotherapy trials excluded patients with EGFR and ALK, but did not necessarily exclude patients with HER–2 mutations. Given the impressive survival outcomes seen with immunotherapy and chemoimmunotherapy, personally, I would...

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Medical Oncology · Lung Cancer Research Foundation (LCRF)

Answered on

I would use Chemo + IO for a patient with PDL1>1% and HER2 mutation. However, since it is still unclear about the outcomes of IO in HER2+ patients, I would not be inclined to use IO as a single agent. I would use chemo/IO combination in all these instances, PDL1 1-49% or >50%. In the second-line, I ...

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Medical Oncology · Mary Lanning Healthcare Morrison Cancer Center/University of Nebraska Medical Center Adjunct Faculty

Answered on

HER2 alterations in non-small-cell lung cancer can include gene mutations (1%-4% of cases), gene amplifications (2%-5%) or protein overexpressions (2%-30%) which can lead to different prognostic and predictive outcomes. Non-selective tyrosine kinase inhibitors (TKI) have shown a minor benefit in HER...

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