Selecting Candidates for HER2 TKIs

In this episode, Dr Julia Rotow discusses practical considerations for selecting patients with HER2-mutant NSCLC for HER2-directed TKIs. She reviews key safety signals, including liver enzyme elevations, rash, and diarrhea, and outlines recommended monitoring strategies and dose-adjustment approaches. She also examines real-world clinical factors that may influence selection of oral TKIs, such as comorbidities, prior immune-related pneumonitis, and patient preference for oral versus intravenous therapy. The discussion then transitions into the presentation of Case 2: a 72-year-old man with HER2 exon 20 insertion–positive NSCLC and concurrent HER2 IHC 3+ overexpression, highlighting that genomic HER2 alterations and HER2 protein overexpression may occur together. Dr Rotow evaluates the patient’s frontline and second-line treatment history and the implications of his comorbid conditions, including moderate COPD and prior pneumonitis.