The Current Landscape for ex14 Skipping Mutations in Non-Small Cell Lung Cancer.

Capmatinib and tepotinib received US Food and Drug Administration (FDA) approval for mesenchymal-epithelial transition () exon 14 (ex14) skipping alteration in 2020 and 2021, respectively. Capmatinib was FDA approved in May 2020 under accelerated approval for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have a mutation that leads to ex14 skipping. Accelerated approval was based on overall response rate and response duration to capmatinib, and it was granted orphan drug and breakthrough therapy designation. Capmatinib is a potent selective kinase inhibitor of the MET receptor, crosses the blood-brain barrier, and has shown low-grade adverse events. Based on phase II data, capmatinib demonstrated an overall response rate (ORR) of 41% and a median duration of response (DOR) of 9.7 months in those who previously received one or two lines of therapy. In treatment-naive patients, capmatinib demonstrated a 68% ORR with a median DOR of 12.6 months. The FDA also granted accelerated approval to tepotinib for adult patients with metastatic NSCLC harboring ex14 skipping alteration. Accelerated approval for tepotinib was based on an ORR of 43% with a median DOR of 10.8 months in treatment-naive patients. Among previously treated patients, the ORR was 43% with a median DOR of 11.1 months. Continued approval for capmatinib and tepotinib is contingent upon confirmatory trials. Both agents are now considered first-line therapy or a subsequent therapy option in patients with metastatic NSCLC who are positive for ex14 skipping alterations.