The Butterfly Flies - Practice Changing Results of PAPILLON, First Line Chemotherapy and Amivantamab for the Treatment of NSCLC Patients with EGFR Exon 20 Insertions

Dalia Kaakour; Misako Nagasaka

doi:10.2147/LCTT.S454736

The Butterfly Flies - Practice Changing Results of PAPILLON, First Line Chemotherapy and Amivantamab for the Treatment of NSCLC Patients with EGFR Exon 20 Insertions

Lung Cancer (Auckl). 2024 Apr 23:15:49-54. doi: 10.2147/LCTT.S454736. eCollection 2024.

Authors

Dalia Kaakour¹, Misako Nagasaka^{1

2}

Affiliations

¹ Department of Internal Medicine, Division of Hematology and Oncology, University of California Irvine School of Medicine Chao Family Cancer Center, Orange, CA, USA.
² Department of Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.

Abstract

Epidermal growth factor receptor (EGFR) exon 20 insertions are a rare subtype of EGFR mutations that do not respond to EGFR tyrosine kinase inhibitors developed for sensitizing mutations. In 2021, two drugs, amivantamab and mobocertinib each received FDA accelerated approval for second line use after platinum based therapy. These drugs were then brought to first line setting clinical trials; PAPILLON and EXCLAIM2. PAPILLON, which compared amivantamab plus chemotherapy to chemotherapy was positive, whereas EXCLAIM2, which compared mobocertinib to chemotherapy was negative. The PAPILLON regimen received subsequent FDA approval. In this commentary, we review the details of PAPILLON and also discuss why the rival trial, EXCLAIM2, may have failed.

Keywords: EGFR; bispecific antibody; epidermal growth factor receptor; first line therapy; mobocertinib; targeted therapy.