Comparing PAPILLON and WU-KONG28 in First-Line Selection

Pasi A. Jänne, MD, PhD, of Dana-Farber Cancer Institute, asks Lyudmila Bazhenova, MD, of UC San Diego Moores Cancer Center, how to weigh PAPILLON against WU-KONG28 in first-line EGFR exon 20 insertion–mutated non–small cell lung cancer without a head-to-head trial. She sees similar efficacy: median progression-free survival of 11.4 vs 10 months, median overall survival of 34.3 vs 29.8 months, and response rates of 73% with amivantamab plus chemotherapy vs 59% with sunvozertinib. Toxicity differs, with more diarrhea and creatine kinase elevation with sunvozertinib and more neutropenia, paronychia, and infusion reactions with amivantamab plus chemotherapy. Both trials excluded untreated brain metastases, so she might favor the oral agent for brain metastases though she lacks central nervous system data for sunvozertinib. Dr Jänne expects real-world experience to guide the choice, notes some patients decline chemotherapy, and says prior amivantamab does not appear to reduce sunvozertinib efficacy, while reverse-order data are scarce.