Top Line: Do patients with EGFR mutated, stage III NSCLC benefit from adjuvant EGFR targeted therapy?
The Study: Chemoradiation followed by adjuvant durvalumab is the standard treatment for unresectable stage III NSCLC. This regimen typically applies to all NSCLC regardless of molecular status. However, some wonder whether patients with EGFR mutations actually benefit from durvalumab and whether they may benefit more from EGFR targeted therapy. A small post-hoc analysis of 35 EGFR mutated patients in the PACIFIC trial found that PFS and OS outcomes with durvalumab were not significantly better than placebo. Here’s a larger retrospective study of 136 patients with EGFR mutated, stage III NSCLC treated with chemoradiation. Among these, 41% received adjuvant durvalumab, 24% received adjuvant osimertinib, and 35% received no adjuvant therapy. At 24 months, the rate of PFS was significantly higher among patients treated with adjuvant osimertinib (86%) compared to both durvalumab (30%) and observation (27%). However, there was no difference in observed OS. There was no significant difference in the rate of adverse events between osimertinib and durvalumab (52% v 48%).
TBL: This retrospective study suggests patients with EGFR mutated, stage III NSCLC treated with chemoradiation may have better outcomes with adjuvant osimertinib than with durvalumab. | Nassar, J Thorac Oncol 2024
The Study: Chemoradiation followed by adjuvant durvalumab is the standard treatment for unresectable stage III NSCLC. This regimen typically applies to all NSCLC regardless of molecular status. However, some wonder whether patients with EGFR mutations actually benefit from durvalumab and whether they may benefit more from EGFR targeted therapy. A small post-hoc analysis of 35 EGFR mutated patients in the PACIFIC trial found that PFS and OS outcomes with durvalumab were not significantly better than placebo. Here’s a larger retrospective study of 136 patients with EGFR mutated, stage III NSCLC treated with chemoradiation. Among these, 41% received adjuvant durvalumab, 24% received adjuvant osimertinib, and 35% received no adjuvant therapy. At 24 months, the rate of PFS was significantly higher among patients treated with adjuvant osimertinib (86%) compared to both durvalumab (30%) and observation (27%). However, there was no difference in observed OS. There was no significant difference in the rate of adverse events between osimertinib and durvalumab (52% v 48%).
TBL: This retrospective study suggests patients with EGFR mutated, stage III NSCLC treated with chemoradiation may have better outcomes with adjuvant osimertinib than with durvalumab. | Nassar, J Thorac Oncol 2024