FLAURA2: Osimertinib and Chemotherapy in Frontline EGFR-Mutant NSCLC

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 Levy discusses updated FLAURA2 data for patients with EGFR-mutant NSCLC [non–small cell lung cancer] with brain metastases showing improved intracranial response rates and delayed CNS progression with upfront chemotherapy-osimertinib versus osimertinib alone. Dr Garassino states this high-risk population is the most compelling for using chemotherapy-osimertinib upfront. Dr Garon notes patients with exon 21 mutations like L858R have shorter PFS [progression-free survival] on osimertinib but derive similar chemotherapy-osimertinib benefit to patients with exon 19 mutations. Dr Peters cautions about potential neurocognitive issues with radiation and feels data is still lacking on its optimal use with TKIs [tyrosine kinase inhibitors].

In conclusion, the experts agree the updated FLAURA2 results support using chemotherapy-osimertinib up front in patients with EGFR-mutant NSCLC at high risk of rapid CNS progression, like those with active brain metastases. However, Dr Garon notes some younger patients still hope for longer-term survival and may prefer sequential chemotherapy after progression on TKI monotherapy.

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