Osimertinib May Offer Survival Benefit Over Immunotherapy in Some Patients With Unresectable NSCLC

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Investigators have found that the targeted therapy osimertinib may be associated with improved progression-free survival when administered after chemotherapy and radiation in patients with non–small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations, according to a recent study published by Nassar et al in the Journal of Thoracic Oncology.


Patients with EGFR-mutated NSCLC tend to not respond well to immunotherapy treatments, including durvalumab.

“Osimertinib is a drug that is actually very specific for the EGFR mutation itself,” explained co–lead study author Amin Nassar, MD, a member of the Yale Cancer Center. “It has proven to be very efficacious in the stage IV setting and also, more recently with the ADAURA trial, in the stage III setting. We wanted to find out in the unresectable stage III population, are we going to see similar benefits, and is this targeted therapy actually better than immunotherapy for these specific patients?”

Study Methods and Results

In the retrospective study, the investigators used 2015 to 2022 data to compare the survival outcomes among 136 patients with stage III EGFR-mutated NSCLC who received treatment with durvalumab, osimertinib, or neither treatment following chemotherapy and radiation.

The investigators discovered that the patients who received osimertinib experienced a 2-year progression-free survival rate of 86% compared with 30% and 27% among those who received durvalumab or neither treatment, respectively.

The investigators reported that only 6% of the patients who received osimertinib experienced severe side effects compared with 18% among those treated with durvalumab. The most common side effect was pneumonitis, but the investigators found no unexpected safety risks during the study.


The investigators stressed that larger studies may be needed to determine the overall survival benefit of osimertinib as consolidation therapy for unresectable EGFR-mutated NSCLC.

“In the ADAURA trial, patients with resectable stage III NSCLC receive surgical resection followed by chemotherapy and then osimertinib. With that, they achieve not only better progression-free survival but also overall survival. That’s the current standard of care,” underscored Dr. Nassar. “However, in the unresectable population, this is the only data we have right now that shows that there is also a progression-free survival benefit when treated with osimertinib for these … patients with the EGFR mutation. We expect to see preliminary results from the LAURA study in the next couple of months. The question will be, is there an overall survival benefit as well?” he concluded.

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