Current clinical practice and physicians' insights on Chinese patients with advanced non-small cell lung cancer habouring epidermal growth factor receptor 20 insertion mutation

Abstract

Background: The present study aimed to investigate physicians' perspectives on the diagnosis and treatment decisions for patients with non-small cell lung cancer (NSCLC) harbouring epidermal growth factor receptor (EGFR) exon 20 insertion (exon20ins) mutations in a real-world setting in China using an online questionnaire.

Methods: This study was performed via the CAPTRA-Lung collaboration between December 9, 2022 and March 6, 2023. The questionnaire was distributed digitally to physicians around China and was comprised of three sections: basic characteristics of surveyed physicians, diagnosis and treatment status of NSCLC patients with the EGFR exon20ins-mutation, and physicians' perspectives on treatment options. Physicians who treat more than 10 patients with advanced NSCLC every month and who have treated patients with advanced EGFR exon20ins-mutant NSCLC in the past six months were involved in this study.

Results: A total of 53,729 questionnaires were distributed and 390 valid ones were collected. The EGFR mutation test was performed in 80.9% and 59.9% of patients receiving first-line or second-line therapy and beyond (hereinafter "second-line")therapy, respectively. In terms of treatment options, chemotherapy plus antiangiogenic therapy was the most common treatment option (30.0% of patients in first-line settings; 25.0% of patients in second-line settings), and a certain proportion of patients received novel EGFR exon20ins-targeted agents (including tyrosine kinase inhibitors [TKIs] and bispecific antibodies) in first- or second-line settings, which accounted for 11.9% and 15.7% of all treated patients, respectively. Additionally, physicians reported the highest satisfaction score for the efficacy and safety of targeted agents. Most physicians believed that EGFR exon20ins-targeted TKIs represented the most promising treatment option (80.2% in first-line treatment and 73.3% in second-line treatment). Among several novel agents under study, sunvozertinib has received the highest recognition for efficacy and safety.

Conclusions: This study investigated the current diagnosis and treatment status and physicians' perspective, of patients with EGFR exon20ins-mutant NSCLC. The results highlight significant unmet clinical needs in this subgroup of patients. EGFR exon20ins-targeted TKIs were recognized as the most promising treatment regimen and may benefit more patients considering their awareness and acceptance of targeted therapy.

Keywords: EGFR exon20ins; Questionnaire; Real-world clinical practice; Targeted agents.

Fig. 1

Region distribution of the 390 questionnaires collected in this study. Note: The first-tier cities: Beijing, Shanghai, Guangzhou, Shenzhen; The new first-tier cities: Tianjin, Chongqing, Hefei, Foshan, Zhengzhou, Wuhan, Changsha, Nanjing, Suzhou, Qingdao, Xi’an, Chengdu, Hangzhou, Ningbo; The second-tier cities: Fuzhou, Quanzhou, Xiamen, Lanzhou, Huizhou, Zhongshan, Nanning, Guiyang, Baoding, Shijiazhuang, Harbin, Changchun, Changzhou, Nantong, Wuxi, Xuzhou, Nanchang, Dalian, Shenyang, Jinan, Linyi, Weifang, Yantai, Taiyuan, Kunming, Jinhua, Shaoxing, Wenzhou; The third-tier cities: Anqing, Fuyang, Wuhu, Ningde, Putian, Zhangzhou, Chaozhou, Qingyuan, Shantou, Zhanjiang, Guilin, Liuzhou, Haikou, Lang fang, Tangshan, Kaifeng, Luoyang, Nanyang, Xinxiang, Jingzhou, Yueyang, Zhuzhou, Huai’an, Taizhou, Yancheng, Zhenjiang, Ganzhou, Jiujiang, Shangrao, Hohhot, Yinchuan, Heze, Jining, Liaocheng, Weihai, Zibo, Xianyang, Urumqi, Huzhou, Taizhou; The fourth-tier cities: Bozhou, Huaibei, Huangshan, Tongling, Maoming, Baise, Chengde, Jiaozuo, Pingdingshan, Shiyan, Xiaogan, Huaihua, Loudi, Yiyang, Jilin, Dandong, Jinzhou, Baotou, Binzhou, Dongying, Zaozhuang, Jinzhong, Linfen, Dazhou, Leshan, Neijiang, Yibin; The fifth-tier cities: Wuwei, Qinzhou, Jingmen, Siping, Pingxiang, Xinyu, HuLudao, Liaoyang, Hulunbuir, Zigong, Shihezi

Fig. 2

The results of questions concerning physicians’ understanding of EGFR exon20-ins mutations (n = 390). A. Is EGFR exon20ins mutation a primary mutation or an acquired drug-resistance mutation? (single-choice); B. Where do EGFR exon20in mutations occur? (multiple-choice); C. Which are EGFR exon20ins mutations? (multiple-choice); D. Which one of the following subtype is sensitive to 1st -3rd generation EGFR TKIs? (single-choice). EGFR, epidermal growth factor receptor; TKI, tyrosine kinase inhibitor

Fig. 3

A. Proportions of physicians using first-line and second-line therapy in EGFR exon20ins-mutant patients. B. Physicians’ scaling scores for the efficacy and safety of each therapy. Notes On a scale of 1–7, a score of 1 indicates the lowest level of satisfaction, and a score of 7 indicates the highest level of satisfaction. * ICI-based combination therapies, including ICI + chemo + VEGF(R)i, ICI + VEGF(R)i, etc. **1st -3rd generation TKI alone or in combination. *** EGFR exon20ins-targeted agents include TKIs and bispecific antibodies. Chemo, chemotherapy; VEGF(R)i, vascular endothelial growth factor (receptor)-targeted inhibitor; ICI, immune checkpoint inhibitor; EGFR, epidermal growth factor receptor; Gen, generation; TKI, tyrosine kinase inhibitor

Fig. 4

Physicians’ views on the most promising therapy for EGFR exon20ins-positive patients (A), and the novel targeted agents with the highest efficacy and best safety (B). *1st -3rd generation TKI alone or in combination. ** ICI-based combination therapies, including ICI + chemo + VEGF(R)i, ICI + VEGF(R)i, etc. EGFR, epidermal growth factor receptor; TKI, tyrosine kinase inhibitor; BsAb, bispecific antibody; ICI, immune checkpoint inhibitor; Combo, combination; Chemo, chemotherapy; VEGF(R)i, vascular endothelial growth factor (receptor)-targeted inhibitor

Fig. 5

The most important indicators for physicians in choosing novel targeted agents. OS, overall survival; PFS, progression-free survival; ORR, objective response rate; AEs, adverse events