MARIPOSA Survival Benefit and First-Line Treatment Selection

Elizabeth Dennis, MSN, APRN, FNP-C, explains how overall survival data from the MARIPOSA trial changed the first-line conversation for patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer. She notes that osimertinib remains an effective standard, while amivantamab plus lazertinib demonstrated an overall survival benefit, shifting the goal from delaying progression to helping patients live longer. Ms. Dennis emphasizes individualized treatment. She considers amivantamab plus lazertinib for patients appropriate for combination therapy and able to manage added monitoring and toxicities; osimertinib monotherapy for patients who are frailer, have significant comorbidities, or prioritize tolerability and a simpler oral regimen; and osimertinib plus chemotherapy for patients with substantial disease burden or progression risk who can tolerate chemotherapy. Acknowledging that no head-to-head comparison of these regimens exists, she tells patients that more intensive treatment may offer greater benefit along with additional side effects. Her goal is to help patients live longer and live well.