Top Line: Does adjuvant osimertinib reduce the risk of brain metastases in patients with stage III, EGFR-mutated NSCLC?
The Study: The LAURA trial showed a dramatic improvement in progression free survival when osimertinib was given after chemoradiation for stage III, EGFR-mutated NSCLC. This study specifically analyzed CNS outcomes from LAURA. Off the bad, an interesting finding was that among enrolled patients felt to have no brain metastases at baseline, 10% in the osimertinib arm and 7% in the placebo arm actually had mets after MRI review by an independent neuroradiologist. Brain MRI was performed along with body imaging every 8 weeks for the first year of follow up. Overall, 20% of osimertinib patients and 41% of placebo patients had CNS PFS events. Osimertinib significantly reduced the risk of CNS progression or death by 83%. At 12 months, the cumulative incidence of CNS progression was 9% v 36%, and at 24 months it was 12% v 37%. A final interesting finding was that local progression rather than distant progression was the most common type of progression in both arms (21% v 48%).
TBL: EGFR-mutated NSCLC patients have a relatively high risk of CNS progression likely meriting regular surveillance imaging of the brain. Adjuvant osimertinib significantly reduces the risk of CNS progression following definitive chemoradiation. | Lu, Ann Oncol 2024
The Study: The LAURA trial showed a dramatic improvement in progression free survival when osimertinib was given after chemoradiation for stage III, EGFR-mutated NSCLC. This study specifically analyzed CNS outcomes from LAURA. Off the bad, an interesting finding was that among enrolled patients felt to have no brain metastases at baseline, 10% in the osimertinib arm and 7% in the placebo arm actually had mets after MRI review by an independent neuroradiologist. Brain MRI was performed along with body imaging every 8 weeks for the first year of follow up. Overall, 20% of osimertinib patients and 41% of placebo patients had CNS PFS events. Osimertinib significantly reduced the risk of CNS progression or death by 83%. At 12 months, the cumulative incidence of CNS progression was 9% v 36%, and at 24 months it was 12% v 37%. A final interesting finding was that local progression rather than distant progression was the most common type of progression in both arms (21% v 48%).
TBL: EGFR-mutated NSCLC patients have a relatively high risk of CNS progression likely meriting regular surveillance imaging of the brain. Adjuvant osimertinib significantly reduces the risk of CNS progression following definitive chemoradiation. | Lu, Ann Oncol 2024