Formal study discussant Johan Vansteenkiste, MD, of the University Hospitals KU Leuven, Belgium, commented on the ADAURA trial findings: “This is an impressive effect on disease-free survival [with osimertinib] and a very early snapshot of overall survival.”

Dr. Vansteenkiste continued: “In the CNS disease-free analysis, osimertinib has good tolerability and control of CNS disease. In the early stages of NSCLC, it is improving cure rates. It is a well-done study, with impressive early disease-free survival and immature overall survival. Osimertinib exerts superior CNS control.”

Johan Vansteenkiste, MD

Clinical Implications for Patient Selection

“Minimal disease after surgery is likely to be eliminated after chemotherapy,” he commented. “However, a substantial proportion of early-stage disease is cured by surgery alone. This brings up the question of whether to use osimertinib for all patients. We have to consider that about 50% of patients will develop diarrhea, and 22% with develop skin problems for a median duration of 22 months. Plus, there is financial toxicity.”

According to Dr. Vansteenkiste, measuring minimal residual disease is crucial in selecting patients for treatment. “At the time of relapse, we have a powerful treatment. The question is, do you need to give it to all patients or act upon disease progression when you see it? Until we have mature overall survival data, I would not implement adjuvant osimertinib in all patients. Osimertinib probably has a role in patients with minimal residual disease and in stage IV disease.” 

DISCLOSURE: Dr. Vansteenkiste has received honoraria from AstraZeneca, Bristol Myers Squibb, MSD Oncology, and Roche; has served as an institutional consultant or advisor to AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, MSD Oncology, Novartis, and Roche; and has received institutional research funding from MSD.