Key Considerations When Selecting EGFR Inhibitor Treatments in NSCLC

Panelists discuss how the treatment landscape for EGFR-mutant non–small cell lung cancer has evolved with new combination therapies like osimertinib plus chemotherapy (FLAURA2) and amivantamab plus lazertinib (MARIPOSA) challenging osimertinib monotherapy as the standard of care.

Panelists discuss how conversations with patients about treatment options have become more complex and nuanced, requiring thorough explanation of efficacy data and adverse effects while adapting to each patient’s level of understanding and involvement.

Panelists discuss how the overall survival benefit from the MARIPOSA regimen (amivantamab plus lazertinib) with a hazard ratio of 0.75 and projected survival improvement exceeding 1 year represents a significant advancement that must be weighed against toxicity concerns.

Panelists discuss how quality of life considerations, including prophylactic medications to prevent dermatologic toxicities and infusion-related reactions, are crucial when implementing EGFR-targeted therapies, especially the MARIPOSA regimen.

Panelists discuss how subsequent therapy after initial disease progression should consider patient symptomatology, biomarker testing through tissue or liquid biopsies, and potential treatment options including MET-targeted approaches or chemotherapy combinations.

Panelists discuss how many patients never receive second-line therapy, emphasizing the critical importance of selecting the optimal first-line treatment and monitoring patients closely to identify progression early.

Panelists discuss how central nervous system (CNS) progression presents unique challenges in treatment decision-making, highlighting the importance of brain imaging surveillance and considering approaches that maintain CNS disease control while addressing systemic progression.

Panelists discuss how optimizing treatment duration, using local therapy for oligometastatic disease, and understanding the limitations of current biomarkers are important considerations in developing effective sequencing strategies for EGFR-mutant lung cancer.

Panelists discuss how implementing the new standard of combination therapies requires thorough patient education, prophylactic management of toxicities, and multidisciplinary support to optimize outcomes for patients with EGFR-mutant lung cancer.