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Topics:
Lung Cancer • Thoracic Malignancies • Medical Oncology • Her2+ • Journal Club ft. NEJM publications
How would you approach treatment of a patient with metastatic NSCLC with PD-L1>1% and HER2-mutation?
Does this change for PDL1 1-49% vs >50%? Will you be more likely to employ other checkpoint inhibitors before use of HER2 targeting therapy? Or start with targeted therapy and reserve checkpoint inhibitors for later lines?
Answer from: Medical Oncologist at Academic Institution
No, I do not believe that this changes anything for that population. The immunotherapy trials excluded patients with EGFR and ALK, but did not necessarily exclude patients with HER–2 mutations. Given the impressive survival outcomes seen with immunotherapy and chemoimmunotherapy, personally, I...
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Answer from: Medical Oncologist at Community Practice
I would use Chemo + IO for a patient with PDL1>1% and HER2 mutation. However, since it is still unclear about the outcomes of IO in HER2+ patients, I would not be inclined to use IO as a single agent. I would use chemo/IO combination in all these instances, PDL1 1-49% or >50%. In the second-li...
Answer from: Medical Oncologist at Community Practice
HER2 alterations in non-small-cell lung cancer can include gene mutations (1%-4% of cases), gene amplifications (2%-5%) or protein overexpressions (2%-30%) which can lead to different prognostic and predictive outcomes. Non-selective tyrosine kinase inhibitors (TKI) have shown a minor benefit in HER...