Lung cancer is one of the most common cancers worldwide, with 2.2 million new cases diagnosed in 2020. Even with substantial improvement in cancer screening, diagnosis, and treatment over the past few decades, lung cancer remains the leading cause of cancer death*, with approximately 18% of cancer-related deaths worldwide.
In 2019, Belgium counted 8.874 patients with lung cancer. (www.kankerregister.org)
Non-small cell lung cancer (NSCLC) is the most common type, aﬀecting 85 % of lung cancer patients. Takeda is focused on extending and improving the lives of people living with rare forms of NSCLC, including anaplastic lymphoma kinase-positive (ALK+) metastatic NSCLC (mNSCLC) and epidermal growth factor receptor (EGFR) Exon20 insertion+ mNSCLC.
*Sung et al., CA CANCER J CLIN 2021;71:209–249
Anaplastic lymphoma kinase-positive (ALK+) NSCLC is a unique type of NSCLC caused by a change in the anaplastic lymphoma kinase (ALK) gene, and accounts for about 3% to 5% of people with NSCLC.
ALK+ NSCLC patients tend to have a more advanced stage of the disease upon diagnosis and may experience the spread of the disease to their brain. In fact, as many as 75% of people with ALK+ NSCLC will ultimately develop brain metastases during the course of their disease.4,5
1 Gainor JF, Varghese AM, Ou SH, et al. ALK rearrangements are mutually exclusive with mutations in EGFR or KRAS: an analysis of 1,683 patients with non-small cell lung cancer. Clin Cancer Res. 2013;19(15):4273-4281.
2 Koivunen JP, Mermel C, Zejnullahu K, et al. EML4-ALK fusion gene and efficacy of an ALK kinase inhibitor in lung cancer. Clin Cancer Res. 2008;14(13):4275-4283.
3 Wong DW, Leung EL, So KK, et al. The EML4-ALK fusion gene is involved in various histologic types of lung cancers from nonsmokers with wild-type EGFR and KRAS. Cancer. 2009;115(8):1723-1733.
4 Johung et al. JCO ; 34(2), January 2016. 5 Rangachari et al. Lung Cancer ; 88(2015), 108-11
Similar to anaplastic lymphoma kinase-positive (ALK+) NSCLC, EGFR-positive NSCLC is driven by a mutation in the EGFR (epidermal growth factor receptor) gene. EGFR mutations occur predominantly in exons 18, 19, 20, or 21.
Although rare, insertions and/or duplications in exon 20 account for ~1-2% of all NSCLC.
Historically, patients with EGFR exon 20 insertions have been treated with chemotherapy, although EGFR tyrosine kinase inhibitors (TKIs) or immunotherapies are also used. To identify patients with EGFR exon20 insertion mutations, comprehensive genomic testing is crucial.
Expanded genomic testing and the continued investigation of novel therapies are needed to help identify and ultimately improve outcomes for people living with EGFR exon20 insertion+ mNSCLC.
1 Riess JW, Gandara DR, Frampton GM, et al. J Thorac Oncol. 2018;13(10):1560-1568.
2 Fang W, Huang Y, Hong S, et al. BMC cancer 2019;19,1-9.
3 Oxnard GR, Lo PC, Nishino M, et al. J Thorac Oncol. 2013;8(2):179-184.