The Value of Testing in The Expanding EGFR Exon 20 Insertion Landscape

Chul Kim, MD, MPH, spoke with CancerNetwork^® about the evolving first-line treatment landscape for non–small cell lung cancer harboring EGFR exon 20 insertion mutations following the final overall survival analysis of the phase 3 PAPILLON trial (NCT04538664), which he presented at the IASLC 2026 World Conference on Lung Cancer (WCLC).¹

According to Kim, director of Thoracic Oncology at MedStar Georgetown University Hospital, and associate professor at Georgetown University, although efficacy has been encouraging with novel regimens for EGFR exon 20 insertion mutation–positive disease, more work must be done to mitigate toxicities. He also emphasized access to testing and treating as key considerations in the field alongside new therapeutic options.

Transcript:

What do you hope others take away from this conversation and the research you presented?

Kim: We’re making a lot of good progress in patients with EGFR exon 20 insertion-mutated non-small cell lung cancer. We’ve seen very encouraging efficacy across many different regimens. One of the things we have to continue to work on is mitigating [adverse] effects. With amivantamab[-vmjw; Rybrevant]-based regimens, we now have the phase 2 COCOON [NCT06120140] regimen, the subcutaneous formulation, and other mitigation strategies.² For other regimens, we have to look into how we can best support patients through supportive care. Those are aspects we should not ignore and should continue to work on.

One thing I’d add is that access to testing and treatment globally is a very important issue. EGFR exon 20 insertion mutations are best detected by comprehensive next-generation sequencing rather than individual gene testing by PCR because we miss up to 50% of important EGFR exon 20 variants by using individual PCR testing alone. We’ve made a lot of progress on therapeutic treatment options, but to bring these advances to patients worldwide, we have to think a lot about how we make testing and these treatment advances available for patients globally.

References

1. Kim C, Tang K-J, Cho BC, et al. First-line amivantamab-chemotherapy vs chemotherapy in EGFR exon 20 insertion-mutated non-small cell lung cancer: overall survival from PAPILLON. Presented at: 2026 World Conference on Lung Cancer; September 12-15, 2026; Seoul, South Korea. Abstract PL03.03.
2. Cho BC, Li W, Spira AI, et al. Enhanced versus standard dermatologic management with amivantamab-lazertinib in EGFR-mutated advanced NSCLC: the COCOON global randomized controlled trial. J Thorac Oncol. 2025;20(9):1517-1530. doi:10.1016/j.jtho.2025.07.117