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. 2019 Apr;51(2):623-631.
doi: 10.4143/crt.2018.151. Epub 2018 Jul 23.

Clinical Outcomes of EGFR Exon 20 Insertion Mutations in Advanced Non-small Cell Lung Cancer in Korea

Seonggyu Byeon  1 , Youjin Kim  1 , Sung Won Lim  1 , Jang Ho Cho  1 , Sehoon Park  1 , Jiyun Lee  1 , Jong-Mu Sun  1 , Yoon-La Choi  2 , Se-Hoon Lee  1 , Jin Seok Ahn  1 , Keunchil Park  1 , Myung-Ju Ahn  1
Affiliations

Clinical Outcomes of EGFR Exon 20 Insertion Mutations in Advanced Non-small Cell Lung Cancer in Korea

Seonggyu Byeon et al. Cancer Res Treat. 2019 Apr.

Abstract

Purpose: Epidermal growth factor receptor (EGFR) exon 20 insertion mutations account for approximately 4% of all EGFR mutations. Given the rarity of this mutation, its clinical outcomes are not fully established.

Materials and methods: Between 2009 and 2017, non-small cell lung cancer (NSCLC) patients who showed an exon 20 insertion were retrospectively reviewed for clinical characteristics and outcomes, including responses to chemotherapy (CTx) or targeted therapy.

Results: Of 3,539 NSCLC patients who harbored an activating EGFR mutation, 56 (1.6%) had an exon 20 insertion. Of the advanced NSCLC patients, 27 of 1,479 (1.8%) had an exon 20 insertion. The median overall survival was 29.4 months (95% confidence interval 9.3 to 49.6) for 27 advancedNSCLC patients. The 22 patientswho received systemic CTx achieved a 50.0% response rate and a 77.2% disease control rate, with 4.2 months of progressionfree survival. Six patients received EGFR tyrosine kinase inhibitors (TKIs). Three of the four patients that had only an exon 20 insertion showed progressive disease, while one showed stable disease. The othertwo patients had an exon 20 insertion and another EGFR mutation and achieved a partial response.

Conclusion: The incidence of an exon 20 insertion mutation is rare in Korea and occasionally accompanied by other common EGFR mutations. Although the response to systemic CTx. in these patients is comparable to that of patients with other mutations, the response rate to firstor second-generation EGFR TKIs is quite low. Therefore, the development of a more efficient agent is urgently needed.

Keywords: EGFR tyrosine kinase inhibitor; Epidermal growth factor receptor; Exon 20 insertion; Mutation; Non-small cell lung cancer.

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Conflict of interest statement

Conflict of interest relevant to this article was not reported.

Figures

Fig. 1.
Fig. 1.
Distribution of epidermal growth factor receptor (EGFR) mutations in advanced non-small cell lung cancer patients (n=1,479).
Fig. 2.
Fig. 2.
Kaplan-Meier survival curves. (A) Progression-free survival of patients with an exon 20 insertion receiving systemic chemotherapy. (B) Overall survival of patients with an exon 20 insertion. NSCLC, non-small cell lung cancer.
See this image and copyright information in PMC

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