Optimizing Frontline Treatment Approaches in EGFRm Metastatic NSCLC - Episode 8
Impact of Disease Characteristics on 1L Treatment Decisions in EGFRm NSCLC
Panelists discuss how disease characteristics such as central nervous system (CNS) metastases can influence treatment decisions, with both FLAURA2 and MARIPOSA trials showing superior outcomes for patients with brain metastases when using combination therapies.
Disease Characteristics Influencing Treatment Selection
Main Discussion Topics:
- Impact of specific disease features on treatment decisions
- Role of CNS metastases in guiding therapy selection
- Identification of high-risk features that benefit from treatment escalation
Key Points for Physicians:
- Both FLAURA2 and MARIPOSA demonstrated superior CNS efficacy compared with osimertinib monotherapy
- High-risk features benefiting from combination therapy include TP53/RB alterations, high disease burden, liver metastases, and CNS involvement
- Hazard ratios show particularly strong benefit for patients with brain metastases (HR, 0.47 in FLAURA2; HR, 0.67 for overall survival in MARIPOSA)
Notable Insights:
Combination therapy approaches may allow some patients with brain metastases to avoid radiation therapy.
Clinical Significance:
Patients with CNS disease and other high-risk features represent a subgroup with a particularly strong rationale for intensification of first-line therapy beyond osimertinib monotherapy.
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