Overall Survival and Systemic Efficacy of First-Line Regimens in EGFR-Mutant NSCLC

Dr. Rodriguez turns to overall survival (OS), the second question Mr. Smith and his wife raised. For MARIPOSA, median OS has not yet been reached for amivantamab plus lazertinib, with more than half of patients projected to be alive beyond 4 years based on the current data. Patients randomized to osimertinib monotherapy in MARIPOSA have reached a median OS of approximately 36 months. Duration of response is approximately 25.8 months with the combination versus 16.8 months with monotherapy, and time to symptomatic progression is reported as significantly delayed in the combination arm. Dr. Rodriguez notes that this last endpoint is relevant for a patient like Mr. Smith, who wants to understand not only survival but day-to-day function on therapy.

For FLAURA2, the OS data have already read out: median OS of 47.5 months with osimertinib plus chemotherapy versus approximately 38 months with osimertinib monotherapy. Dr. Rodriguez notes that FLAURA2 is currently the only first-line regimen in this space with a reported median OS, and contextualizes the result against historical EGFR-positive monotherapy outcomes in the 16- to 18-month range.

Her overall message to patients: both combination regimens show an OS advantage over monotherapy and improved CNS efficacy compared with monotherapy. The remaining decision comes down to feasibility, specifically which regimen aligns best with the patient’s treatment schedule, tolerability, and logistics.

In the next episode, “CNS Surveillance and Long-Term Management in EGFR-Mutant NSCLC With Brain Metastases,” Dr. Rodriguez reviews how she monitors CNS disease once treatment has started.