Osimertinib Monotherapy vs Combination Therapy in First-Line NSCLC

Jiaxin (Jason) Niu, MD, reviews first-line treatment options for EGFR-mutant metastatic non–small cell lung cancer (NSCLC), noting that osimertinib monotherapy was the preferred first-line therapy based on the FLAURA trial, which began in 2018. He explains that the treatment landscape changed in 2024 with 2 new phase 3 combination options: FLAURA2, which pairs osimertinib with platinum-pemetrexed chemotherapy followed by osimertinib-pemetrexed maintenance, and MARIPOSA, a chemotherapy-free approach combining osimertinib with amivantamab, a bispecific antibody targeting EGFR and MET. Dr. Niu reports that both trials showed a meaningful progression-free survival benefit of roughly 9 months over osimertinib alone, with MARIPOSA's overall survival not yet reached and FLAURA2's improving from 36 to 45 months.