A medical oncologist reviews the efficacy and safety outcomes from the ADAURA trial investigating osimertinib in resected EGFR-mutated NSCLC and discusses how biomarkers inform treatment selection.
Case: A 60-Year-Old Woman with Early-Stage Non–Small Cell Lung Cancer
Initial presentation and Clinical Workup
This is a video synopsis/summary of a Case-Based Peer Perspectives featuring Sandip P. Patel, MD.
The ADAURA trial demonstrated that adjuvant osimertinib after surgery and chemotherapy significantly improves disease-free and overall survival in early-stage EGFR-mutant non–small cell lung cancer (NSCLC). Over 3 years of osimertinib decreased the risk of disease recurrence/death without concerning new safety signals.
For all NSCLC patients including early-stage cases, Patel obtains PD-L1, EGFR mutation, and ALK fusion testing to help guide optimal treatment. In this EGFR exon 19 deletion–positive case with high PD-L1 expression, he notes PD-L1 testing alone could be misleading, as immune checkpoint blockade is not appropriate following osimertinib and increases pneumonitis risk. With an actionable EGFR mutation in localized disease, his approach after lung surgery would be adjuvant cisplatin/pemetrexed chemotherapy for 4 cycles, then osimertinib for 3 years per ADAURA.
For disease progression after 2 years on osimertinib with new liver and brain metastases, he advocates biopsy of new lesions to assess histology, additional targetable alterations, and guide next-line therapy, including consideration of stereotactic radiosurgery.
Video synopsis is AI-generated and reviewed by Targeted Oncology™ editorial staff.