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Updated: Jan 13, 2026
Author Spotlight: Advancements in Molecular Biomarker Testing for Non-Squamous Non-Small Cell Lung Cancer
Published on: September 8, 2023
Patient preferences for EGFR mutation-targeted therapies in non-small cell lung cancer, with a focus on Exon 20
Jaein Seo1, Eileen Curran2, Jennifer A Whitty3
1PPD Evidera Patient-Centered Research, Thermo Fisher Scientific, Waltham, MA, USA.
Introduction:
This study investigated treatment preferences of patients with non-small cell lung cancer (NSCLC) and epidermal growth factor receptor (EGFR) mutations, e.g., exon 20 insertion (ex20ins), and assessed the trade-offs they were willing to make among treatment benefits, risks and administration.
Methods:
Adults in the US with NSCLC harboring EGFR mutations like EGFRex20ins were recruited via physician referrals or a patient advocacy group. A multidimensional thresholding exercise was administered online, including ranking/point allocation and adaptive trade-off questions choosing between treatment options, each described by two of six attributes (disease control rate [DCR], treatment regimen and severe risks of diarrhea, nausea/vomiting, rash, fatigue). Relative attribute weights (RAW) and maximum acceptable loss of DCR for improvement in another attribute were estimated.
Results:
167 patients participated (mean age 60 [standard deviation = 10.2], 65 % female, 37 % EGFRex20ins, 93 % Stage IV). Key drivers of treatment choice were improving DCR from 60 % to 90 % (RAW = 33.1 %), reducing severe diarrhea risk from 30 % to 0 % (RAW = 18.1 %), improving regimen (RAW = 15.2 %), reducing severe nausea/vomiting risk from 10 % to 0 % (RAW = 14.0 %), reducing severe rash risk from 10 % to 0 % (RAW = 10.0 %), and reducing severe fatigue risk from 10 % to 0 % (RAW = 9.6 %). Participants were willing to forgo 5.4 % - 12.7 % DCR to reduce the risk of severe adverse events by 10 % and up to 11.7 % DCR to have a preferred treatment regimen.
Conclusions:
NSCLC patients with EGFR mutations, including EGFRex20ins, highly value efficacy but also consider other attributes like adverse event risks and regimen. Future drug development and treatment decisions should address these aspects.
Insights
Patients with non-small cell lung cancer (NSCLC) and EGFR mutations prioritize treatment efficacy but also value reduced side effects and convenient regimens. These preferences should guide future drug development and clinical decisions.
Area of Science:
- Oncology
- Medical Economics
- Patient-Reported Outcomes
Background:
- Non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations presents unique treatment challenges.
- EGFR mutations, including exon 20 insertion (ex20ins), necessitate understanding patient preferences for optimal therapeutic strategies.
Purpose of the Study:
- To investigate the treatment preferences of NSCLC patients with EGFR mutations, specifically focusing on trade-offs between benefits, risks, and administration.
- To quantify the relative importance of disease control, adverse event reduction, and treatment regimen in patient decision-making.
Main Methods:
- A cohort of adult US patients with NSCLC and EGFR mutations was recruited.
- A multidimensional thresholding exercise, including adaptive trade-off questions, was used to assess patient preferences and estimate relative attribute weights (RAW).
Main Results:
- Improving disease control rate (DCR) from 60% to 90% was the most significant driver (RAW=33.1%).
- Reducing severe diarrhea risk (RAW=18.1%) and improving treatment regimen (RAW=15.2%) were also highly valued.
- Patients were willing to forgo DCR to reduce severe adverse events and prefer simpler regimens.
Conclusions:
- NSCLC patients with EGFR mutations exhibit a strong preference for efficacy but also significantly value the reduction of adverse events and treatment regimen convenience.
- These patient-centric preferences are crucial for informing future drug development and clinical treatment decisions in this population.
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