Dramatic response to tepotinib in a highly symptomatic patient with metastatic MET exon 14 skipping non-small cell lung cancer and poor performance status: A case report

Targeted therapies are recommended for treatment of patients with non-small cell lung cancer (NSCLC) with actionable driver mutations, including those with poor performance status, who otherwise have limited treatment options. However, clinical trial evidence in patients with poor performance status is often sparse, especially for newer drug classes. Tepotinib, an oral, once-daily MET inhibitor, was recently approved for the treatment of advanced/metastatic NSCLC with MET exon 14 (METex14) skipping based on the durable clinical activity observed in the Phase II VISION trial. We report an excellent response to tepotinib in a patient with metastatic NSCLC with METex14 skipping, which was achieved despite a poor baseline Eastern Cooperative Oncology Group performance status (ECOG PS) of 3, substantial symptom burden, and prior intolerance to chemotherapy. The patient attained a rapid, near-complete radiographic response, evident from the first tumor assessment at 2 months, which was maintained for >8 months (ongoing at the time of writing) and correlated with the alleviation of all disease-related symptoms and improvement in ECOG PS to 0. Tepotinib was well tolerated despite the poor clinical condition and prior intolerance to chemotherapy. This case report provides real-world evidence for the clinical effectiveness of tepotinib and indicates that a dramatic response can be attained without clinically significant adverse events, even in a patient who would typically be ineligible for clinical trials due to poor ECOG PS.