Significance of FLAURA in EGFR+ NSCLC

Sai-Hong Ignatius Ou, MD, PhD: The publication on the FLAURA data and the approval of osimertinib as a frontline treatment option in EGFR-mutant non—small cell lung cancer has changed the landscape of the treatment of this disease. Right now, I’m using osimertinib exclusively as a frontline treatment option for patients with EGFR-mutant lung cancer. There are 3 advantages of osimertinib over the first-generation EGFR TKIs [tyrosine kinase inhibitors]. No. 1, the progression-free survival is improved by approximately 6 to 7 months [18.9 months versus 10 months] over first-generation EGFR TKI therapy. No. 2, osimertinib has proven CNS [central nervous system] activity, where the first-generation EGFR TKIs do not. And No. 3, osimertinib is really well tolerated. The adverse effects are minimal compared to first-generation EGFR TKI therapy. So based on the efficacy and the CNS activity, there’s no reason not to use osimertinib as a frontline treatment option in EGFR-mutant non—small cell lung cancer.

In the past several years, the development and approval of osimertinib in EGFR T790M mutations, and, subsequently, in EGFR-mutant lung cancer has changed the landscape for the treatment of EGFR-mutant lung cancer. The significant improvement is not just in the improved clinical efficacy, but also in the tolerability. The fact that osimertinib is very well tolerated compared to the first-generation EGFR TKI therapy is a significant improvement in the treatment of this disease.

In the past, when osimertinib was initially approved, it was approved for the treatment of EGFR-mutant lung cancer with T790M mutations that appear after first-generation EGFR TKI therapy. Right now, osimertinib is also approved for the frontline treatment of EGFR-mutant lung cancer. So in most of the patients I have, I start with osimertinib. I do not wait for the emergence of the EGFR T790M mutations. As we have more and more experience with osimertinib available, and with the approval of the availability of osimertinib in the United States—I think it’s now close to 2 to 3 years—we are seeing less and less patients with T790M mutations because we are not putting these patients on first-generation EGFR TKI therapy anymore.

Transcript Edited for Clarity