First-Line Treatment Options in EGFR-Mutated Advanced NSCLC

Edgardo Santos, MD, FACP, FASCO, of Starling Oncology in Fort Lauderdale, Florida, opens this OncLive My Treatment Approach discussion with Wade Iams, MD, MSCI, of Tennessee Oncology in Nashville, Tennessee, on first-line therapy for EGFR-mutated advanced non–small cell lung cancer (NSCLC). Dr Iams outlines 3 options for a patient with a newly diagnosed EGFR exon 19 deletion or L858R mutation. Two are combinations: amivantamab plus lazertinib, studied intravenously in MARIPOSA and given subcutaneously in COPERNICUS, and platinum-based chemotherapy plus osimertinib, the FLAURA2 regimen. The third is osimertinib monotherapy, which Dr Iams says now fits a steadily shrinking group of patients. He notes that both combinations have shown a clear overall survival benefit over osimertinib alone, and says he steers patients toward a combination whenever they can tolerate one. Dr Santos previews the program, which covers efficacy data, how the subcutaneous regimen is started, and the prophylactic strategies that begin alongside treatment.