What Does EGFR+ Lung Cancer Mean?

EGFR stands for epidermal growth factor receptor. EGFR is a protein that helps cells grow. However, a change (mutation) in the gene for EGFR can cause cells to grow too fast. This abnormal growth can cause cancer.¹

Having EGFR+ lung cancer means a person with non-small cell lung cancer (NSCLC) has tested positive for the EGFR mutation. In the United States, about 10 to 15 percent of people have EGFR+ lung cancer. However, in the Asian population, rates are higher. In fact, among Asian-American women, many of whom are non-smokers, the rates have increased by 2 percent each year.^1,2

EGFR was the first mutation discovered as a target for personalized treatment in lung cancer. Now, there are various treatment options for people living with EGFR+ lung cancer.³

Treatment options for EGFR+ lung cancer

Besides chemotherapy and radiation therapy, there are other treatments available for EGFR+ lung cancer. These include:^1,3

Surgery

For early-stage EGFR+ lung cancer, surgery may be an option to completely remove the lung cancer. Unfortunately, lung cancer is often diagnosed at a later stage. Therefore, treatment aims to slow the growth of the cancer and decrease symptoms.^1,3,4

EGFR inhibitors

An EGFR inhibitor is a type of targeted therapy. It is also called a tyrosine kinase inhibitor (TKI) and comes in pill form. EGFR inhibitors block the EGFR protein from telling cells to grow. This can help stop the spread of cancer. There are several examples of EGFR inhibitors.^1,3,5

For early and advanced EGFR+ lung cancer:^1,3,5

• Tagrisso® (osimertinib)

For advanced EGFR+ lung cancer:^1,3,5

• Gilotrif® (afatinib)
• Vizimpro® (dacomitinib)
• Tarceva® (erlotinib)
• Iressa® (gefitinib)

Tagrisso is often the first treatment prescribed for EGFR+ lung cancer. It can help combat the spread of cancer to the brain. Some people receive Tagrisso after surgery or chemotherapy. This can help prevent lung cancer from coming back (recurrence).^1,3,5-7

In some cases, Tarceva is given along with Cyramza® (ramucirumab). Cyramza is a type of vascular endothelial growth factor (VEGF) inhibitor. It works by preventing the formation of blood vessels that feed cancer growth. Together, Tarceva and Cyramza can help control cancer.^3,5

Combination therapies

Recent advancements have introduced combination therapies for first-line treatment of advanced or metastatic NSCLC with EGFR exon 19 deletions or L858R mutations. Some examples of combination therapies include:^1,5

• Rybrevant® (amivantamab-vmjw) with Lazcluze® (lazertinib)
• Tagrisso with chemotherapy

Side effects of EGFR inhibitors

Common side effects of using an EGFR inhibitor include:⁵

• Skin issues, such as an acne-like rash
• Diarrhea
• Loss of appetite
• Mouth sores
• Nail changes
• Fatigue

Resistance to EGFR inhibitors

Cancer cells are constantly changing. This can lead to the development of new mutations. These new mutations may be resistant to the EGFR inhibitor being used. This is called treatment resistance. This can happen within several months or even years.¹

When treatment resistance occurs, a repeat biomarker test is recommended. This test can reveal if there is a new mutation and which treatment option will be best going forward.¹

For instance, some lung cancers have an EGFR mutation called exon 20 insertion mutation. This mutation requires a different treatment approach than other EGFR mutations.¹

Treating lung cancer with an exon 20 insertion mutation

Typical EGFR inhibitors are less effective on the exon 20 insertion mutation. Chemotherapy remains a treatment option, but there are also several targeted therapies available. These include:^1,5,8,9

• Rybrevant® (amivantamab-vmjw) – This drug is the first targeted therapy developed for the exon 20 insertion mutation. It is given as an IV infusion. Rybrevant blocks the action of 2 proteins that help cancer cells grow, EGFR and MET. Rybrevant can also be used in combination with chemotherapy as a first-line treatment for people with EGFR exon 20 insertion mutations.
• Sunvozertinib – This drug has received FDA breakthrough therapy designation as a frontline treatment for people with previously treated NSCLC with EGFR exon 20 insertion mutations. It is given as a pill. So far, clinical trials have shown very promising results.
• Exkivity (mobocertinib) – Mobocertinib is an EGFR inhibitor specifically designed for the exon 20 insertion mutation. In 2023, Exkivity was voluntarily withdrawn from the market in the US due to issues with confirmatory trial results, though it may still be available in some other regions or clinical trial settings.

There are few targeted therapies for the exon 20 insertion mutation, but research continues to expand these options. Many clinical trials are trying to change that. They are researching potential drugs that can treat this mutation more effectively. Talk to your doctor regarding these trials. You may be eligible to participate.³