EGFR-mutated mNSCLC: Sharing Clinical Insights and Best Practices - Episode 4
Real-World Utilization of Monotherapy and Combination Therapy in the Frontline Setting
Experts discuss the slow but growing real-world adoption of combination therapy for EGFR-mutant non–small cell lung cancer (NSCLC) despite strong FLAURA2 survival data, citing factors such as clinical inertia, comfort with monotherapy, and regional practice variations, while anticipating broader uptake as confidence, education, and infrastructure catch up with the evolving standard of care.
The panel turned its attention to how the recent clinical trial data isare translating into real-world practice. Despite compelling survival data from the FLAURA2 study, early real-world evidence presented at the conference showed limited uptake of the combination regimen. The majority of patients receiving treatment for EGFR-mutant NSCLC were still being treated with monotherapy. This reflects a lag between trial data publication and changes in prescribing behavior, particularly when oncologists and patients are more comfortable with established approaches.
One explanation offered for this slower adoption was the familiarity and ease of prescribing monotherapy compared towith transitioning patients to more complex regimens. Additionally, it often takes time for clinicians to update their practices—especially without definitive survival data at the time of initial study releases. However, panelists noted that in their own communities, particularly in areas with academic affiliations or access to continuing education, uptake of the combination approach is beginning to increase. The fact that the chemotherapy backbone in FLAURA2 is well known and widely used may also be helping to drive broader acceptance.
There was also a discussion of how regional practice differences can shape adoption. In some areas, community oncologists were noted to have embraced FLAURA2 more quickly than expected—sometimes even ahead of academic peers who were waiting for more mature survival outcomes. It was acknowledged that practice change is a process, influenced by comfort with treatment protocols, patient logistics, and timing of next-generation sequencing results. Ultimately, with the survival benefit now confirmed, the expectation is that adoption will continue to grow steadily, especially as oncologists become more confident in presenting the combination as a viable standard of care. Access, experience, and local infrastructure will all play a role in shaping how fast this shift occurs across different care settings.
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