Post ELCC Perspectives: Global Data With EGFR TKIs in Advanced NSCLC - Episode 1

Osimertinib in Advanced EGFR T790M-Mutant NSCLC


Sai-Hong Ignatius Ou, MD, PhD: The management of EGFR-mutated lung cancer has changed dramatically the last few years based on the AURA3 study and the phase III FLAURA trial. The AURA3 study demonstrated that osimertinib is better than chemotherapy in EGFR-mutated and also T790M non—small cell lung cancer. The FLAURA study demonstrated that osimertinib, a third-generation EGFR TKI [tyrosine kinase inhibitor], has improved progression-free survival more than the first-generation EGFR TKI and also with better tolerability and better CNS [central nervous system] activity. Based on the FLAURA study, I think most of the clinicians in the United States are using osimertinib as a frontline treatment.

As far as real-world data, I think they confirm what the FLAURA study demonstrated, and it’s good to see that the real-world study mirrors the phase III clinical trial.

The Wang abstract shows that the real-world use of osimertinib in EGFR-mutated non—small cell lung cancer that harbors the resistant T790M mutation has very good survival. In the United States, even the FLAURA study is positive, and we have osimertinib approval for close to 2 years now. Most of the use of osimertinib is now in the frontline setting. As we move on, we are likely to see that many patients will develop the T790M mutation. But in the real-world study, it shows that it confirms the AURA3 study. If patients develop T790M on a first or second-generation EGFR TKI, then osimertinib should be the treatment of choice.

The overall survival from the time of the diagnosis and for patients who develop T790 mutations and are treated with osimertinib is around 55 years. The overall survival from the time of use of osimertinib in patients with T790M mutations is about 24 months.

The line of therapy in the real-world study did not affect the overall survival benefit from osimertinib. The use of osimertinib with local therapy did improve survival in the real-world study, too, which is expected especially in patients with brain metastasis, and is also expected because of the superior CNS activity of osimertinib.

Transcript Edited for Clarity