Xiuning Le, MD, PhD

Xiuning Le, MD, PhD, assistant professor in the department of thoracic/head and neck medical oncology at The University of Texas MD Anderson Cancer Center, discusses counseling patients on the use of amivantamab-vmjw (Rybrevant) and mobocertinib (Exkivity) and the sequencing of these drugs for patients with non–small cell lung cancer (NSCLC) and an 

Both of these agents are approved by the FDA as second-line therapy following disease progression during or after receiving platinum-based chemotherapy for NSCLC for patients with an 

exon 20 insertion mutation. Le says that amivantamab and mobocertinib can be used in very similar settings based on discussions with the patient. Amivantamab is administered as an intravenous (IV) therapy while mobocertinib is an oral agent, which may affect patient preference.

Since amivantamab and mobocertinib have different mechanisms of action, it is likely that they can offer benefit in sequence if patients have disease progression after receiving either of the targeted agents in the second line. Amivantamab is a bispecific antibody that targets 

, while mobocertinib is a small molecule EGFR tyrosine kinase inhibitor.

Using both agents sequentially following frontline chemotherapy can offer the most disease control for patients whose NSCLC recurs or does not respond to treatment.

 I discuss both of the drugs [with patients], because if you look at FDA approval, both of the drugs are approved for 

 exon 20 insertion lung cancer after the patient has been exposed to chemotherapy, or the patient can't tolerate the chemotherapy, so in very similar settings. Each of the patients will have their own ideas of IV versus oral medication, how important they view certain parameters on efficacy....I do tell my patients, though, because the 2 medications work so differently, [and] 1 is IV, 1 is oral, so that if the tumor progressed on 1 drug, we can potentially try the other. The resistance mechanisms probably have very little overlapping. Again, it's a good thing that we have more than 1 option that we can probably sequentially use them to give our patients the maximal time that have disease control.

Videos

Xiuning Le, MD, PhD, discusses counseling patients on the use of amivantamab-vmjw and mobocertinib and the sequencing of these drugs for patients with non–small cell lung cancer and an EGFR exon 20 insertion.

Using and Sequencing EGFR Exon 20-Targeted Therapies for NSCLC

Xiuning Le, MD, PhD, assistant professor, Department of Thoracic/Head and Neck Medical Oncology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center in Houston, Texas discusses the limited treatment options available for patients with non–small cell lung cancer (NSCLC) and an 

There is currently no FDA approved agent to treat patients with 

 or HER2 exon 20-positive NSCLC. Targeting these oncogenes is a great unmet medical need, explains Le, and although chemotherapy is still an option to treat patients with 

-positive NSCLC, it is important use all the tools that are available to treat this patient population.

Introducing a small molecule tyrosine kinase inhibitor such as poziotinib is important for the future treatment of 

 and HER exon 20-positive NSCLC. The hope is to bring more options to field.

Xiuning Le, MD, PhD, discusses the limited treatment options available for patients with non–small cell lung cancer and an EGFR exon 20 mutation.










Filling in the Treatment Gap for Patients With EGFR+ NSCLC

Xiuning Le, MD, PhD, an assistant professor in the Department of Thoracic Head and Neck Medical Oncology, Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discusses the results of tepotinib (Tepmetko) in patients with advanced non-small cell lung cancer (NSCLC) and a MET exon 14 skipping mutation.

The phase 2 VISION trial (NCT02864992) was massively positive, says Le. In the 99 patients the investigators could report on, there was about 46% objective response rate. To get a real response, she says the tumor has to shrink by at least 30%. In the 99 patients, there was 90% tumor shrinkage.

Le says the hypothesis for the study was correct due to these findings. The small molecule inhibitor tepotinib works on the tumor and induces tumor shrinkage. There were some patients with more tumor shrinkage than others on the trial, but overall the results were positive and showed that tepotinib works for this patient population.

There was a median progression-free survival of 8.6 months with this drug by independent review committee and 9.5 months by investigator assessment.

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Xiuning Le, MD, PhD, discusses the results of tepotinib in patients with advanced non-small cell lung cancer and a MET exon 14 skipping mutation.

Xiuning Le, MD, PhD | Authors

Articles

Using and Sequencing EGFR Exon 20-Targeted Therapies for NSCLC

Filling in the Treatment Gap for Patients With EGFR+ NSCLC

VISION Trial Produces Positive Data in NSCLC With MET Exon 14 Mutations