Understanding NSCLC Treatment When You Have an EGFR Mutation

*Please note: This slide show is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult your doctor about any questions you may have regarding a medical condition.

What is an EGFR mutation?

Your genes contain instructions that tell your body how to work. Mutations, or changes, in genes can change the way your body works.

What is an EGFR mutation?

Certain gene mutations can lead cancer to form or drive it to grow and spread. These "driver mutations" are common in non-small cell lung cancer, or NSCLC. EGFR mutations are one kind of driver mutation.¹

How are EGFR mutations found and what do they do?

Biomarker testing finds driver mutations and other changes that can help your doctor treat cancer more effectively. It is done by testing a sample of tumor tissue or blood.

How are EGFR mutations found and what do they do?

EGFR proteins help cells grow and multiply. Mutations in EGFR can cause these proteins to become too active. The signal that tells cells to grow is constantly turned on, instead of only turned on when needed. The result is uncontrolled cell growth that leads to cancer.

Are EGFR mutations common in NSCLC?

EGFR mutations are fairly common in NSCLC, occurring in 15-20% of tumors, mostly adenocarcinomas.²

EGFR mutations are more common in people from East Asia, including China, Japan, and Korea. About 35% of people with this heritage and NSCLC have them. Women and nonsmokers are also more likely to have this mutation.³

Targeted therapy for EGFR mutations

The good news is that specific treatments can target EGFR mutations. If you have an EGFR mutation, you may be a candidate for targeted therapy, and there are many treatments that target EGFR.

These therapies are in the form of drugs that act on the mutation directly or turn off the EGFR switches, or receptors, on the cell surfaces. Both ways can stop these cells from growing and spreading as fast.

Tyrosine kinase inhibitors

Tyrosine kinase inhibitors, or TKIs, are the most frequently used targeted therapy. These drugs can help people with EGFR mutations live longer.

TKIs approved for EGFR mutations include erlotinib (Tarceva^®), gefitinib (Iressa^®), osimertinib (Tagrisso^®), afatinib (Gilotrif^®), and dacomitinib (Vizimpro^®).³ More drugs are constantly being approved, so ask your doctor about any new targeted therapies.

When are tyrosine kinase inhibitors used?

Most TKIs are approved to treat stage 4 NSCLC, when the cancer has spread outside the lungs.

When are tyrosine kinase inhibitors used?

One TKI, Osimertinib (Tagrisso^®), is approved to treat NSCLC at early stages. If you have surgery to remove lung cancer, you may receive osimertinib to decrease the chance of cancer coming back and increase the likelihood of living longer. Researchers are also studying treatments for cancers that resist osimertinib.⁵

Side effects of EGFR inhibitors

Other EGFR inhibitors also have side effects. These can include skin infections or an acne-like rash, diarrhea, mouth sores, and a loss of appetite.⁸

Treatments for other EGFR mutations

About 12% of EGFR-positive cancers have a type of EGFR mutation called an exon 20 insertion.²

If you have this mutation, you may take amivantamab (Rybrevant^®), which is given by IV,⁶ with or after chemotherapy.

A monoclonal antibody and its side effects

Amivantamab (Rybrevant^®) is a different type of drug, called a monoclonal antibody, used to treat non-small cell lung cancer with an EGFR exon 20 insertion mutation.

Amivantamab can cause an allergy-like reaction when given by IV. The nursing staff will watch for this. As with all medications, call your doctor if you notice any new symptoms or think you might be having a side effect.

Importance of repeat biomarker testing

Knowing if you have an EGFR mutation can lead to more effective treatment for NSCLC. This can mean living longer without the cancer progressing.

Cancer cells with EGFR mutations can become resistant, so it is important to repeat biomarker testing if treatment stops working at any time. A different drug can make treatment more effective again.

Clinical trials for NSCLC with EGFR mutations

All the current treatments for NSCLC, including those targeting specific driver mutations, were developed in clinical trials. Joining a trial could help you now and will help other people in the future as new drugs are developed.

Do not hesitate to ask your doctor about clinical trials if you have an EGFR mutation. Research is happening every day to find new lung cancer treatments and improve the outlook for people with lung cancer.

References

1. Chevallier M, Borgeaud M, Addeo A, Friedlaender A. Oncogenic driver mutations in non-small cell lung cancer: Past, present, and future. World J Clin Oncol. 2021 Apr 24;12(4):217-237.
2. Pecci F, Cantini L, Metro G, Ricciuti B, Lamberti G, Farooqi AA, Berardi R. Non-small-cell lung cancer: how to manage EGFR-mutated disease. Drugs Context. 2022 Aug 3;11:2022-4-1.
3. Abourehab MAS, Alqahtani AM, Youssif BGM, Gouda AM. Globally Approved EGFR Inhibitors: Insights into Their Syntheses, Target Kinases, Biological Activities, Receptor Interactions, and Metabolism. Molecules. 2021 Nov 4;26(21):6677.
4. OncoLink.org. Non-Small Cell Lung Cancer: Staging and Treatment. Last revised: May 22, 2023.
   https://www.oncolink.org/cancers/lung/non-small-cell-lung-cancer-nsclc/non-small-cell-lung-cancer-staging-and-treatment
5. Masciadrelli M. Lung adenocarcinomas: New findings about resistance to targeted therapies. Yale Cancer Center. August 3, 2023.
   https://www.yalecancercenter.org/news-article/lung-adenocarcinomas-new-findings-about-resistance-to-targeted-therapies
6. OncoLink.org. Amivantamab-vmjw (Rybrevant^®). Last revised: June 12, 2023.
   https://www.oncolink.org/cancer-treatment/oncolink-rx/amivantamab-vmjw-rybrevant-r
7. OncoLink.org. Mobocertinib (Exkivity™). Last revised: September 13, 2023.
   https://www.oncolink.org/cancer-treatment/oncolink-rx/mobocertinib-exkivity
8. Healthline.com. An Overview of EGFR-Positive Lung Cancer. Last revised: January 5, 2023.
   https://www.healthline.com/health/lung-cancer/egfr-mutation-lung-cancer