Front-line osimertinib improves overall survival in EGFR-mutation positive NSCLC

First-line osimertinib significantly lengthens overall survival compared to older generation EGFR-TKIs in patients with Ex19del/L858R EGFR mutated advanced non-small cell lung cancer (NSCLC), according to late breaking results of the FLAURA trial presented at the ESMO Congress 2019 in Barcelona, Spain.

The primary endpoint of progression free survival (PFS) was previously reported. Survival data are now mature: the median overall survival with osimertinib was 38.6 months versus 31.8 months with first generation EGFR-TKIs, with a hazard ratio of 0.799 (p=0.0462). More than half (54%) of patients in the osimertinib group were alive at three years compared to 44% in the standard care group.

“The survival results are both statistically significant and clinically meaningful with first-line osimertinib for EGFR mutated patients,” said study author Prof Suresh Ramalingam, Winship Cancer Institute of Emory University, Atlanta, US. “This is the first time a TKI has proven to extend survival relative to another TKI in lung cancer therapy.”

Ramalingam noted that after disease progression, 31% of patients in the control group crossed over to the osimertinib arm, representing 47% of patients in the control group that received post-study therapy. “That is consistent with what we would expect in the real-world setting, since only about 50% of patients develop the T790M mutation and will be candidates for osimertinib,” he said.

Ramalingam concluded: “FLAURA met both its primary and key secondary endpoints and showed a favourable safety profile for osimertinib. The results further reinforce the clinical utility and superiority of osimertinib in the front-line setting. Based on these data, osimertinib should be the preferred front-line therapy for EGFR-mutated lung cancer patients.”

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