Boehringer Ingelheim's zongertinib (BI 1810631), an investigational oral tyrosine kinase inhibitor (TKI), is emerging as a promising therapy for non-small cell lung cancer (NSCLC) harboring HER2 mutations. The drug has been granted breakthrough therapy designation by both the FDA and China’s Center for Drug Evaluation, signaling its potential to address a significant unmet need in this patient population.
Approximately 2% to 4% of NSCLC patients, which accounts for 85% of all lung cancer cases, have HER2 mutations, representing about 40,000 individuals globally each year. These patients often have limited treatment options compared to those with other HER2-positive cancers.
The Beamion LUNG-1 phase 1b trial (NCT04886804), presented at the 2024 World Conference on Lung Cancer, evaluated zongertinib in previously treated patients with HER2-mutated NSCLC. The study included 132 patients who received either 120 mg or 240 mg of zongertinib once daily. Results from the 120 mg cohort showed a confirmed objective response rate (ORR) of 66.7% (97.5% CI: 53.8, 77.5; P < 0.0001) based on blind independent central review (BICR).
Activity Against Brain Metastases
Zongertinib also demonstrated encouraging activity in patients with asymptomatic brain metastases. Confirmed ORRs were 33% (120 mg; n = 27) and 40% (240 mg; n = 25) per BICR. Disease control rates were 74% and 92% in the 120 mg and 240 mg groups, respectively.
Tolerability Profile
The trial indicated that zongertinib was generally well-tolerated. There were no fatal treatment-related adverse events (TRAEs). Dose reductions were required in 11% of patients, and treatment discontinuation occurred in only 3% of patients. While 92% and 100% of patients in the 120 mg and 240 mg groups, respectively, experienced any grade of TRAEs, only 17% and 19% had grade 3 or higher TRAEs. The most common adverse effects were grade 1 or 2 diarrhea (43% and 11%, respectively) and grade 1 or 2 rash (19% and 8%, respectively).
Boehringer Ingelheim is currently enrolling patients in the Beamion LUNG-2 study, a phase 3, open-label, randomized, active-controlled trial comparing zongertinib to standard-of-care treatment in patients with unresectable, locally advanced, or metastatic non-squamous HER2-positive NSCLC.
Implications for NSCLC Treatment
If approved, zongertinib could represent a new first-line therapy option for HER2-mutated NSCLC. The drug's efficacy and tolerability profile, along with its activity against brain metastases, position it as a potentially valuable addition to the NSCLC treatment landscape. The ongoing research and development of TKIs like zongertinib underscore the importance of targeted therapies in addressing specific oncogenic drivers in NSCLC and other cancers.
