Dr. Herbst on the Benefit of Adjuvant Osimertinib in EGFR-Mutant NSCLC

Roy S. Herbst, MD, PhD, Ensign Professor of Medicine and professor of pharmacology; chief of medical oncology at Yale Cancer Center and Smilow Cancer Hospital; and associate cancer center director for Translational Research at Yale Cancer Center, discusses the benefit of adjuvant osimertinib (Tagrisso) demonstrated in patients with stage II to IIIA EGFR-mutant non—small cell lung cancer (NSCLC) in the phase 3 ADAURA trial.

The results from ADAURA presented at the 2020 ASCO Virtual Scientific Program speak for themselves, says Herbst. Patients enrolled in the trial received adjuvant treatment with either osimertinib or placebo. Disease-free survival (DFS) served as the trial’s primary end point and investigators targeted a hazard ratio (HR) of 0.70. Results of the trial demonstrated a topline HR of 0.17, which translated to an 83% improvement in the DFS of patients with stage II or III disease who received adjuvant osimertinib versus placebo.

The key secondary analysis was to add in the patients with stage I disease who had the best prognosis, Herbst adds. In the overall population, the HR was 0.21, which translated to a 79% improvement in DFS. These numbers were fantastic, according to Herbst. Investigators assumed that this agent would be active, but the extent to which it was effective shows that this third-generation agent is more active, more potent in areas such as the brain and central nervous system, and better tolerated than earlier-generation agents. Investigators saw this positive activity across many variables, including age, sex, hyper EGFR mutation, whether or not the patient received chemotherapy, geography. All groups were in favor of osimertinib with a tolerable toxicity profile, concludes Herbst.

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