EGFR exon 20 insertion mutation and MET exon 14 skipping mutation in non-small cell lung cancer: a scoping review in the Chinese population.

Background: Epidermal growth factor receptor (EGFR) and mesenchymal-epithelial transition (MET) gene mutations are well established in the pathogenesis of non-small cell lung cancer (NSCLC). However, there is limited understanding about the impact of rare variants, such as EGFR exon 20 insertion mutation (EGFRex20ins) and MET exon 14 skipping mutation (METex14) in the Chinese population even though targeted therapies have been approved in China. We conducted a scoping review to assess the current available evidence of these two mutations in NSCLC in the Chinese population.

Methods: Electronic searches were performed before November 2023. Two investigators independently collected data. Any discrepancies were resolved through discussion with a senior investigator.

Results: We identified 111 studies, involving a total of 159,993 NSCLC Chinese patients. Of the 111 studies, 76 studies reported on EGFRex20ins and 45 reported on METex14. When we evaluated the frequency from studies with at least 1,000 patients, the frequency of EGFRex20ins ranged from 0.02-2.85% of all NSCLC patients and 0.56-6.90% of all EGFR mutations. The frequency of METex14 ranged from 0.08-1.38% of all NSCLC patients and 8.33-56.60% of all MET mutations. The treatments for NSCLC with EGFRex20ins varied depending on the study, and all available treatments have limited therapeutic efficacy and a relatively poor prognosis, and fewer studies have examined the efficacy and effectiveness of treatments for NSCLC with METex14 mutation in the Chinese population.

Conclusions: Despite the recent approval of three targeted therapies in China, there is still insufficient evidence regarding their optimal treatment and therapeutic efficacy for Chinese patients. Further large-scale studies are needed to establish links between these mutations and clinical features at baseline and following treatment. Furthermore, moving forward, the development of novel drugs will be essential to fulfill the clinical unmet needs.