Sunvozertinib Monotherapy in Advanced Lung Adenocarcinoma with EGFR Exon 20 Insertion and High PD-L1 Expression: A Case Report

Abstract: As a key oncogenic driver in non–small-cell lung cancer (NSCLC), epidermal growth factor receptor ( EGFR ) exon 20 insertion mutations account for 2– 5% of EGFR ‐mutated NSCLC cases and display marked heterogeneity. Conventional EGFR tyrosine kinase inhibitors (TKIs) are ineffective against these mutations. Sunvozertinib, an orally administered, potent, and highly selective EGFR -TKI, has been approved in China for second-line treatment of NSCLC harboring EGFR exon 20 insertion mutations. Historically, patients with EGFR exon 20 insertion and high programmed death-ligand 1 (PD-L1) expression often received combined immunotherapy and chemotherapy. In the present case report, we describe a patient who exhibited intolerance to first-line immunochemotherapy and was subsequently switched to sunvozertinib for maintenance therapy. This regimen yielded a prolonged progression-free survival, with manageable safety and tolerability profiles. These findings demonstrated that sunvozertinib could be a promising first-line treatment option for NSCLC patients with EGFR exon 20 insertion. Keywords: EGFR exon 20 insertion, NSCLC, sunvozertinib, PD-L1