Vizimpro (dacomitinib) vs Retsevmo (selpercatinib)

Vizimpro (dacomitinib) is a pan-human epidermal growth factor receptor (HER) inhibitor, specifically used for the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) with EGFR exon 19 deletion or exon 21 L858R substitution mutations. Retsevmo (selpercatinib), on the other hand, is a selective RET kinase inhibitor indicated for the treatment of three types of cancers: NSCLC with RET gene alterations, advanced medullary thyroid cancer (MTC), and other thyroid cancers with RET alterations. When deciding between Vizimpro and Retsevmo, it is crucial to consider the specific genetic alterations present in the tumor, as Vizimpro is specifically for EGFR mutations, while Retsevmo targets RET alterations, making the choice highly dependent on the molecular profile of the cancer.

Difference between Vizimpro and Retsevmo

Metric	Vizimpro (dacomitinib)	Retsevmo (selpercatinib)
Generic name	Dacomitinib	Selpercatinib
Indications	First-line treatment for patients with metastatic non-small cell lung cancer (NSCLC) with EGFR exon 19 deletion or exon 21 L858R substitution mutations	Treatment of adult patients with metastatic RET fusion-positive non-small cell lung cancer (NSCLC), advanced or metastatic RET-mutant medullary thyroid cancer (MTC), and advanced or metastatic RET fusion-positive thyroid cancer
Mechanism of action	Irreversible inhibitor of the epidermal growth factor receptor (EGFR) tyrosine kinase	Selective RET kinase inhibitor
Brand names	Vizimpro	Retsevmo
Administrative route	Oral	Oral
Side effects	Diarrhea, rash, paronychia, stomatitis, decreased appetite, dry skin, decreased weight, alopecia, cough, pruritus	Increased ALT/AST, increased blood glucose, decreased leukocytes, decreased albumin, decreased calcium, dry mouth, diarrhea, increased creatinine, hypertension, fatigue, edema, rash
Contraindications	None known	None known
Drug class	Tyrosine kinase inhibitor	Tyrosine kinase inhibitor
Manufacturer	Pfizer	Eli Lilly and Company

Efficacy

Vizimpro (dacomitinib) Efficacy in Lung Cancer

Vizimpro (dacomitinib) is an oral, once-daily, irreversible pan-human epidermal growth factor receptor (HER) tyrosine kinase inhibitor (TKI). It is specifically indicated for the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 L858R substitution mutations as detected by an FDA-approved test. Clinical trials have demonstrated the efficacy of Vizimpro in this patient population. In a pivotal phase III trial, Vizimpro showed a significant improvement in progression-free survival (PFS) compared to another TKI, gefitinib, in patients with previously untreated, EGFR-mutated NSCLC. The improvement in PFS indicated that Vizimpro could delay the progression of the disease more effectively than the comparator.

Furthermore, the response rate to Vizimpro was high, with a majority of patients experiencing tumor shrinkage. This response was durable, with many patients maintaining their response for a significant period. However, overall survival data were still maturing at the time of the initial analyses, and subsequent updates are required to fully assess the long-term benefits of Vizimpro in terms of overall survival.

Retsevmo (selpercatinib) Efficacy in Lung Cancer

Retsevmo (selpercatinib) is a kinase inhibitor with a specific indication for the treatment of adult patients with metastatic RET fusion-positive NSCLC. Selpercatinib targets rearranged during transfection (RET) alterations, which can drive tumor growth in some cancers, including NSCLC. In clinical studies, Retsevmo has shown significant efficacy in patients with RET fusion-positive NSCLC. The drug demonstrated a high response rate in patients, including those who were previously treated with platinum chemotherapy and those who were treatment-naïve.

The duration of response to Retsevmo has also been noteworthy, with many patients experiencing sustained benefits. Additionally, the therapy has shown activity in the central nervous system, which is particularly important for patients with NSCLC who often develop brain metastases. The clinical trial data have provided a strong rationale for the use of Retsevmo in patients with RET fusion-positive NSCLC, offering a targeted treatment option where there was a significant unmet need.

Regulatory Agency Approvals

Vizimpro

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA

Retsevmo

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA

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