The SINDAS trial established the safety and efficacy of combining radiation and EGFR-targeted therapy (erlotinib in that case) for previously-untreated oligometastatic EGFR-mutant NSCLC.
The Study: How might this carry over to locally-advanced disease? This single-arm phase 2 trial of 24 patients with unresectable stage III EGFR-mutant NSCLC delivered upfront neoadjuvant osimertinib 80 mg daily for 12 weeks. Of 21 evaluable patients, 20 (95%) achieved a complete (n=3) or partial (n=17) response, which was the primary endpoint. Of these, three proceeded to surgery with two downstaged to pT1aN0 disease and one achieving a complete pathologic response. Another 13 proceeded to definitive radiation (no concurrent chemo). When compared to plans generated on initial imaging, there were significant reductions in median target volume and volume of lung receiving 20 Gy. At a median follow-up of 29 months median disease-free survival has not been reached and no serious adverse events have been reported. Induction osimertinib appears a promising strategy to significantly reduce radiation fields and avoid chemo for a majority of patients with unresectable EGFR-mutant NSCLC. | Peled, Int J Radiat Oncol Biol Phys 2023
The Study: How might this carry over to locally-advanced disease? This single-arm phase 2 trial of 24 patients with unresectable stage III EGFR-mutant NSCLC delivered upfront neoadjuvant osimertinib 80 mg daily for 12 weeks. Of 21 evaluable patients, 20 (95%) achieved a complete (n=3) or partial (n=17) response, which was the primary endpoint. Of these, three proceeded to surgery with two downstaged to pT1aN0 disease and one achieving a complete pathologic response. Another 13 proceeded to definitive radiation (no concurrent chemo). When compared to plans generated on initial imaging, there were significant reductions in median target volume and volume of lung receiving 20 Gy. At a median follow-up of 29 months median disease-free survival has not been reached and no serious adverse events have been reported. Induction osimertinib appears a promising strategy to significantly reduce radiation fields and avoid chemo for a majority of patients with unresectable EGFR-mutant NSCLC. | Peled, Int J Radiat Oncol Biol Phys 2023