The Treatment Landscape For Advanced EGFR-Mutant NSCLC
Panelists discuss how the treatment landscape for EGFR-mutant non–small cell lung cancer (NSCLC) has evolved to include 3 viable frontline options (osimertinib alone, osimertinib plus chemotherapy, and amivantamab plus lazertinib), with treatment selection based on patient characteristics, preferences, and physician judgment rather than a strict algorithmic approach.
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The treatment paradigm for EGFR-mutant advanced NSCLC has evolved significantly, transforming from a straightforward single-agent osimertinib approach to a more complex decision-making process involving multiple effective combination regimens. The landscape now includes 3 primary frontline options: osimertinib monotherapy, osimertinib plus chemotherapy (FLAURA2 regimen), and amivantamab plus lazertinib (MARIPOSA regimen). Each option offers distinct advantages and considerations that must be tailored to individual patient characteristics and preferences.
Patient selection criteria play a crucial role in treatment decision-making, with factors including performance status, social support, tumor burden, and patient preference weighing heavily in the choice between regimens. For older patients or patients with frailty with limited support systems, single-agent osimertinib remains an excellent choice due to its favorable tolerability profile. However, for younger, fit patients with good support systems and high tumor burden, combination approaches may offer superior outcomes despite increased complexity and potential toxicity.
The emergence of overall survival data from the MARIPOSA study has added another layer to treatment selection, providing evidence-based support for the amivantamab plus lazertinib combination. However, the decision-making process requires careful consideration of contraindications, particularly the need for anticoagulation with amivantamab, which may preclude its use in patients with bleeding risks or hemorrhagic brain metastases. The evolving landscape emphasizes that there is no universally “right” choice but rather multiple effective options that require personalized approaches through shared decision-making between patients and their oncology teams.
