The survival outcomes of the FLAURA trial support osimertinib as the new first-line standard of care for patients with EGFR-mutated advanced-stage non-small-cell lung cancer in health-care systems that can afford its cost. However, the low crossover rate is a flaw of this study. Knowledge of mechanisms of resistance to provide tailored treatment is the new challenge preventing a continued paradigm shift in this disease.
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References
Soria, J.-C. et al. Osimertinib in untreated EGFR-mutated advanced non-small-cell lung cancer. N. Engl. J. Med. 378, 113–125 (2018).
Ramalingam, S. S. et al. Overall survival with osimertinib in untreated, EGFR-mutated advanced NSCLC. N. Engl. J. Med. 382, 41–50 (2020).
Hosomi, Y. et al. Gefitinib alone versus gefitinib plus chemotherapy for non-small-cell lung cancer with mutated epidermal growth factor receptor: NEJ009 study. J. Clin. Oncol. 38, 115–123 (2020).
Wu, Y. L. et al. Overall survival from the AURA 3 phase III study: osimertinib versus platinum-pemetrexed in patients with EGFR T790M advanced NSCLC and progression on prior EGFR TKI. Ann. Oncol. 30, ix157–ix181 (2019).
Ramalingam, S. S. et al. Mechanisms of acquired resistance to first-line osimertinib: preliminary data from the phase III FLAURA study. Ann. Oncol. https://doi.org/10.1093/annonc/mdy424.063 (2018).
Mok, T. S. et al. Osimertinib or platinum-pemetrexed in EGFR T790M-positive lung cancer. N. Engl. J. Med. 376, 629–640 (2017).
Reungwetwattana, T. et al. CNS response to osimertinib versus standard epidermal growth factor receptor tyrosine kinase inhibitors in patients with untreated EGFR-mutated advanced non-small-cell lung cancer. J. Clin. Oncol. https://doi.org/10.1200/JCO.2018.78.3118 (2018).
Aguiar, P. N. et al. Cost-effectiveness of osimertinib in the first-line treatment of patients with EGFR-mutated advanced non-small cell lung cancer. JAMA Oncol. 4, 1080–1084 (2018).
Yu, H. A. et al. Concurrent alterations in EGFR-mutant lung cancers associated with resistance to EGFR kinase inhibitors and characterization of MTOR as a mediator of resistance. Clin. Cancer Res. 24, 3108–3118 (2018).
Nakagawa, K. et al. Ramucirumab plus erlotinib in patients with untreated, EGFR-mutated, advanced non-small-cell lung cancer (RELAY): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 20, 1655–1669 (2019).
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J.R. has received fees as an advisory member for AstraZeneca, BMS, Boehringer and MSD, as a speaker from Pfizer, travel support from AstraZeneca, BMS, OSE Immunotherapeutics and Roche Genentech, and personal fees from OSE Immunotherapeutics. G.L. works at an institution that receives grant support from AstraZeneca, BMS, Merck and Roche Genentech.
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Japanese University Medical Information Network Clinical Trials Registry: https://www.umin.ac.jp/ctr/
US NIH ClinicalTrials.gov database: https://www.clinicaltrials.gov
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Remon, J., Lopes, G. Upfront osimertinib — winner takes it all?. Nat Rev Clin Oncol 17, 202–203 (2020). https://doi.org/10.1038/s41571-020-0346-6
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DOI: https://doi.org/10.1038/s41571-020-0346-6
