Osimertinib after Chemoradiotherapy in Stage III EGFR-Mutated NSCLC

Author(s): Shun Lu, M.D., Terufumi Kato, M.D., Xiaorong Dong, M.D., Ph.D., Myung-Ju Ahn, M.D., Le-Van Quang, M.D., Nopadol Soparattanapaisarn, M.D., Takako Inoue, M.D., Chih-Liang Wang, M.D., Meijuan Huang, M.D., James Chih-Hsin Yang, M.D., Ph.D., Manuel Cobo, M.D., Mustafa Özgüroğlu, M.D., Ignacio Casarini, M.D., Dang-Van Khiem, M.D., Virote Sriuranpong, M.D., Ph.D., Eduardo Cronemberger, M.D., Toshiaki Takahashi, M.D., Ph.D., Yotsawaj Runglodvatana, M.D., Ming Chen, M.D., Ph.D., Xiangning Huang, Ph.D., Ellie Grainger, M.Sc., Dana Ghiorghiu, M.D., Ph.D., Toon van der Gronde, Pharm.D., Ph.D., and Suresh S. Ramalingam, M.D., for the LAURA Trial Investigators*

Source: 10.1056/NEJMoa24026

Dr. Maen Hussein's Thoughts

Osimertinib resulted in a significant progression-free survival benefit as compared with placebo: the median progression-free survival was 39.1 months with osimertinib versus 5.6 months with placebo in the EGFR mutated patients. Osmiertinib shows efficacy in patients with EGFR mutation who underwent curative surgery or chemoradiotherapy.

BACKGROUND

Osimertinib is a recommended treatment for advanced non–small-cell lung cancer (NSCLC) with an epidermal growth factor receptor (EGFR) mutation and as adjuvant treatment for resected EGFR-mutated NSCLC. EGFR-tyrosine kinase inhibitors have shown preliminary efficacy in unresectable stage III EGFR-mutated NSCLC.

METHODS

In this phase 3, double-blind, placebo-controlled trial, we randomly assigned patients with unresectable EGFR-mutated stage III NSCLC without progression during or after chemoradiotherapy to receive osimertinib or placebo until disease progression occurred (as assessed by blinded independent central review) or the regimen was discontinued. The primary end point was progression-free survival as assessed by blinded independent central review.

RESULTS

A total of 216 patients who had undergone chemoradiotherapy were randomly assigned to receive osimertinib (143 patients) or placebo (73 patients). Osimertinib resulted in a significant progression-free survival benefit as compared with placebo: the median progression-free survival was 39.1 months with osimertinib versus 5.6 months with placebo, with a hazard ratio for disease progression or death of 0.16 (95% confidence interval [CI], 0.10 to 0.24; P<0.001). The percentage of patients who were alive and progression free at 12 months was 74% (95% CI, 65 to 80) with osimertinib and 22% (95% CI, 13 to 32) with placebo. Interim overall survival data (maturity, 20%) showed 36-month overall survival among 84% of patients with osimertinib (95% CI, 75 to 89) and 74% with placebo (95% CI, 57 to 85), with a hazard ratio for death of 0.81 (95% CI, 0.42 to 1.56; P=0.53). The incidence of adverse events of grade 3 or higher was 35% in the osimertinib group and 12% in the placebo group; radiation pneumonitis (majority grade, 1 to 2) was reported in 48% and 38%, respectively. No new safety concerns emerged.

CONCLUSIONS

Treatment with osimertinib resulted in significantly longer progression-free survival than placebo in patients with unresectable stage III EGFR-mutated NSCLC. (Funded by AstraZeneca; LAURA ClinicalTrials.gov number, NCT03521154.)

Author Affiliations

From the Department of Medical Oncology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai (S.L.), the Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan (X.D.), the Division of Thoracic Tumor Multimodality Treatment and Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu (M.H.), the Department of Radiotherapy, the Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), the Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou (M. Chen) — all in China; the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (T.I.), and the Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka (T.T.) — all in Japan; the Department of Hematology–Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (M.-J.A.); the Department of Oncology, Hanoi Medical University (L.-V.Q.), and the Department of Oncology, Vietnam National Lung Hospital (D.-V.K.) — both in Hanoi; the Faculty of Medicine, Siriraj Hospital, Mahidol University (N.S.), the Division of Medical Oncology, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital (V.S.), and the Faculty of Medicine, Vajira Hospital, Navamindradhiraj University (Y.R.) — all in Bangkok, Thailand; the Division of Pulmonary Oncology and Interventional Bronchoscopy, Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan (C.-L.W.), and the Department of Oncology, National Taiwan University Hospital, and the National Taiwan University Cancer Center, Taipei (J.C.-H.Y.) — all in Taiwan; Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain (M. Cobo); the Department of Internal Medicine, Division of Medical Oncology, Clinical Trial Unit, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey (M.Ö.); Servicio Oncología, Hospital Bernardo Houssay, Mar del Plata, Buenos Aires (I.C.); Centro de Pesquisa Clínica, Centro Regional Integrado de Oncologia, Fortaleza, Brazil (E.C.); Biometrics, Late-Stage Development, Oncology Research and Development, AstraZeneca, Cambridge, United Kingdom (X.H., E.G.); Late-Stage Development, Oncology Research and Development, AstraZeneca, Baar, Switzerland (D.G.); Late-Stage Development, Oncology Research and Development, AstraZeneca, New York (T.G.); and the Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.).

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