Dr Spira on Updated MARIPOSA Trial Data in EGFR+ Advanced NSCLC

Alexander I. Spira MD, PhD, FACP, FASCO, codirector, Virginia Cancer Specialists Research Institute, and director, Thoracic and Phase I Program, as well as clinical assistant professor, Johns Hopkins, discusses updated findings from the phase 3 MARIPOSA study (NCT04487080), which is evaluating amivantamab-vmjw (Rybrevant) plus lazertinib (Lazcluze) vs osimertinib (Tagrisso) or lazertinib monotherapy in patients with untreated EGFR-mutated locally advanced or metastatic non–small cell lung cancer (NSCLC).

In August 2024, the FDA approved amivantamab plus lazertinib for the frontline treatment of patients with locally advanced or metastatic NSCLC with EGFR exon 19 deletions or exon 21 L858R substitution mutations, as detected by an FDA-approved test. The regulatory decision was supported by prior findings from MARIPOSA, which demonstrated that the doublet led to a significant progression-free survival benefit compared with osimertinib (HR, 0.70; 95% CI, 0.58-0.85; P = .0002), Spira explains.

Longer-term data presented during the 2024 IASLC World Conference on Lung Cancer showed that at a median follow-up of 31.1 months, patients who received amivantamab plus lazertinib (n = 429) had a median overall survival (OS) of not estimable (NE; 95% CI, NE-NE) compared with 37.3 months (95% CI, 32.5-NE) among those who received osimertinib (HR, 0.77; 95% CI, 0.61-0.96; P = .019). The 24- and 36-month OS rates in the combination arm were 75% (95% CI, 71%-79%) and 61% (95% CI, 56%-67%), respectively, compared with 70% (95% CI, 65%-74%) and 53% (95% CI, 47%-59%), respectively in the osimertinib arm. These findings show that the survival curves are beginning to separate and suggest that there is going to be an OS benefit with the doublet, Spira notes. He concludes by underscoring that the data were not surprising based on what has previously been reported, but they are important.