Optimizing Frontline Treatment Approaches in EGFRm Metastatic NSCLC

Panelists discuss the increasing complexity in treatment decision-making for EGFR-mutant non–small cell lung cancer (NSCLC) with multiple frontline options now available.

Panelists discusses how the MARIPOSA trial demonstrated significant survival improvement with amivantamab plus lazertinib versus osimertinib alone in EGFR-mutant NSCLC, showing a hazard ratio of 0.75 and an expected 12-month survival benefit that could potentially change the natural history of this disease.

Panelists discuss how overall survival is an important but not the only consideration in treatment decision-making, with factors such as patient characteristics, disease burden, and quality of life also being critical.

Panelists discuss how health care providers and patients view survival differently, with providers being more data driven and patients focusing on living with minimal symptoms and maintaining quality of life.

Panelists discuss how treatment choice involves weighing quality of life against treatment burden, considering factors such as hospital visits for infusions vs oral medications at home.

Panelists discuss how explaining survival benefits to patients must be tailored to individual goals and expectations, with many patients having specific life milestones they hope to reach.

Panelists discuss how patient-centered factors are crucial in shared decision-making for first-line (1L) treatment, with a potential default approach of offering combination therapy with an option to choose osimertinib monotherapy.

Panelists discuss how disease characteristics such as central nervous system (CNS) metastases can influence treatment decisions, with both FLAURA2 and MARIPOSA trials showing superior outcomes for patients with brain metastases when using combination therapies.

Panelists discuss how quality-of-life (QoL) considerations and individual toxicity profiles significantly impact first-line (1L) treatment decisions, with different regimens having distinct adverse effect profiles.

Panelists discuss how FLAURA2 maintenance therapy strategies involve monitoring patients for toxicities and implementing dose modifications or schedule adjustments to improve tolerability.

Panelists discuss how the FLAURA2 pemetrexed exposure subanalysis showed that patients could benefit from the regimen even if they didn't complete the full maintenance period as prescribed in the trial.

Panelists discuss how a 56-year-old patient with high-risk disease features was successfully treated with osimertinib plus chemotherapy, achieving excellent response before eventually discontinuing pemetrexed maintenance while continuing osimertinib.

Panelists discuss how a 45-year-old anxious patient who refused chemotherapy was successfully treated with amivantamab plus lazertinib along with prophylactic management strategies for potential adverse effects.

Panelists discuss how despite recent advances in first-line treatments, unmet needs remain. These include better personalized care, community education, understanding resistance mechanisms, central nervous system (CNS) metastases management, and development of novel therapies such as antibody-drug conjugates.