Differentiating Targets and Therapies for Patients With HER2-Mutant Lung Cancer

Lyudmila Bazhenova, MD, discusses the management and treatment of patients with non-small cell lung cancer and a HER2 mutation, a topic she presented at the 2022 Great Debates and Updates in Lung Cancer in Brooklyn, New York.

In her presentation, Dr Bazhenova focused on the need for specific treatments for the different types of HER2-mutant NSCLC, with an emphasis on HER2 exon 20 insertions and the FDA approval of trastuzumab deruxtecan.

Transcript

Hi. I'm Dr. Lyuda Bazhenova. I'm a professor of medicine and thoracic medical oncologist from the University of California - San Diego. Today at the 2022 Great Debates and Updates in Lung Cancer meeting, I discussed the management of patients with non-small cell lung cancer and metastatic disease and a presence of HER2 mutation. It is important to understand that HER2 in lung cancer can be altered by many ways. You can have an amplification of HER2. You can have an overexpression of HER2. The topic of my discussion today was a mutation in HER2 called HER2 exon 20 insertions. Those mutations are rare, found in approximately 2% of the patients. A majority of the patients who have the mutations tend to be never-smokers and tend to be younger. Currently, we have an FDA approval for trastuzumab deruxtecan, which is currently approved in the second-line setting, so for patients who have failed on platinum-doublet chemotherapy. The current approval is based on overall response rate of approximately 50%. Responses appear to be durable and progression-free survival is very respectable as well.

The current approval is for 5.4 mg/kg. That was an FDA decision based on decreased incidence of interstitial lung disease with that dose. This medication is generally well tolerated with the exception of the side effects that are common to chemotherapy such as nausea, neutropenia, alopecia. It is very important to make sure that you test your patients for HER2 exon 20 insertions because we now have an FDA-approved drug to give them.

Source

Bazhenova L. HER2: Differentiating Targets and Therapies. Presented at Great Debates & Updates in Lung Cancer; October 14-15, 2022; Brooklyn, New York.