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HER2-mutant NSCLC T-DXd — SCE Medical Oncology MCQ

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HardLung CancerHER2-mutant NSCLC T-DXdSCE Medical Oncology

A patient with platinum-treated metastatic NSCLC has an ERBB2 exon-20 insertion, no HER2 amplification and HER2 IHC 0. The MDT asks whether trastuzumab deruxtecan is routinely available through a NICE technology-appraisal recommendation in England for this molecular indication. Which answer is accurate?

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Correct answer: E — HER2 mutation differs from expression; TA976 made no NICE recommendation

An ERBB2 exon-20 mutation remains valid despite IHC 0, but NICE TA976 was terminated with no recommendation, so routine NHS access cannot be inferred. HER2 mutation differs from expression; NICE TA976 recommends treatment after platinum: TA976 was terminated and issued no recommendation. HER2 mutation equals amplification; NICE TA976 requires HER2 IHC three-plus: an activating ERBB2 mutation is biologically distinct from overexpression and amplification. HER2 mutation equals expression; NICE breast-cancer guidance governs this NSCLC indication: histology-specific technology appraisal and access cannot be imported from breast cancer. HER2 mutation differs from expression; the UK licence guarantees routine NHS funding: regulatory licensing and NICE commissioning are separate decisions.

Reference: NICE TA976 trastuzumab deruxtecan for HER2-mutated advanced NSCLC (Terminated appraisal published May 2024; current NICE position): https://www.nice.org.uk/guidance/ta976; Enhertu UK summary of product characteristics (Current UK SmPC, updated 2026): https://www.medicines.org.uk/emc/product/12135/smpc