First-Line Treatment for EGFR-Mutant Advanced Lung Cancer

This is a synopsis of a Peer Exchange video series featuring Benjamin P. Levy, MD, of Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Solange Peters, MD, PhD, of University Hospital of Lausanne; Joshua K. Sabari, MD, of NYU Langone’s Perlmutter Cancer Center; Edward B. Garon, MD, MS, of UCLA Jonsson Comprehensive Cancer Center; and Marina Chiara Garassino, MD, of University of Chicago Medicine Comprehensive Cancer Center.

Dr Garassino states she primarily uses osimertinib monotherapy in the first line for EGFR-mutant NSCLC [non–small cell lung cancer], but will consider chemotherapy with osimertinib for high disease burden or brain metastases based on recent FLAURA2 data. Dr Sabari has historically used osimertinib monotherapy even for central nervous system disease given its efficacy and did not routinely use chemotherapy-osimertinib before FLAURA2.

Dr Garon summarizes results from the phase 3 FLAURA2 trial showing improved progression-free survival [PFS] with upfront chemotherapy-osimertinib versus osimertinib alone, but immature overall survival data so far. He states adding chemotherapy toxicity requires strong overall survival benefit to change practice. Identifying biomarkers like TP53 mutations that indicate greater chemotherapy-osimertinib benefit could help select patients most likely to gain increased lifetime from the combination.

In conclusion, FLAURA2 established upfront chemotherapy-osimertinib improves PFS versus sequential chemotherapy after osimertinib progression, but the experts await mature overall survival data before widely adopting the combination. Biomarker identification could help guide optimal patient selection.

*Video synopsis is AI-generated and reviewed by OncLive editorial staff.