Dr. Porter on Potential Sequencing With ADCs and TKIs in HER2+ Lung Cancer

Jason Porter, MD, oncologist/hematologist, director, Lung Cancer disease research group, West Cancer Center and Research Institute, discusses potential sequencing strategies with antibody-drug conjugates (ADCs) and TKIs in HER2-positive lung cancer.

Although cross-trial comparisons are not recommended, the potential integration of TKIs, such as mobocertinib and poziotinib, and ADCs, such as fam-trastuzumab deruxtecan-nxki (Enhertu), for patients with HER2-positive lung cancer raises the question of sequencing, Porter explains.

The TKIs are oral medications that target HER2 specifically and do not require intravenous infusion, Porter says. Given the ongoing COVID-19 pandemic, the utility of outpatient therapy with the TKIs may be preferrable to trastuzumab deruxtecan, Porter explains. However, response and disease control rates with trastuzumab deruxtecan were impressive, and the ADC does not appear to confer the same toxicities that have been observed with the TKIs, Porter says.

Therefore, sequencing is not clear with ADCs and TKIs in HER2-positive lung cancer. There are benefits and drawbacks to utilizing either therapy first, Porter says. Potentially, combination strategies with ADCs and TKIs or either therapy plus chemotherapy will optimize the benefits with these agents in patients with HER2-positive lung cancer, concludes Porter.