Sanjay Popat, FRCP, PhD

“Adjuvant osimertinib has been adopted widespread as a standard of care as a result of the primary results of ADAURA,” said formal discussant Sanjay Popat, FRCP, PhD, medical oncologist and lung specialist at the Royal Marsden Hospital, NHS Foundation Trust, London.

“We have more granularity about effects on stage. All subgroups continue to perform equally well on adjuvant osimertinib,” he noted.

“In stage IB, II, and IIIA, we see an excess of more disease-free survival events. We don’t know if stopping osimertinib after 3 years is optimal. Is 3 years long enough?” he questioned.

“There is also a waning effect over time, which we see in other studies after tyrosine kinase inhibitor discontinuation. What we do know is osimertinib reduces local and distant relapse rate… there seems to be a neuroprotective effect,” he continued.

“The true rate of CNS relapse is likely to be higher than identified, but we do have confidence in non-CNS recurrence rates. The safety shows remarkably stable effects. No new events with longer follow-up,” Dr. Popat continued.

“Despite any criticisms I have, the disease-free survival impact remains strong and is clinically impactful. This is an important treatment option despite no mature survival data,” he stated. “Given the waning over time, these data argue for adjuvant chemotherapy when indicated. I look forward to more data on long-term disease-free survival, minimal residual disease, and overall survival.” 

DISCLOSURES: Dr. Popat reported relationships with Bristol Myers Squibb, Roche, Takeda, AstraZeneca, Pfizer, Merck Sharpe & Dohme, EMD Serono, Guardant Health, Abbvie, Boehringer Ingelheim, OncLive, and Medscape.