TOPLINE:
Consolidated osimertinib given after treatment with chemoradiation delays disease progression significantly longer in patients with EGFR-mutated, stage III non–small cell lung cancer (NSCLC) than durvalumab or observation.
METHODOLOGY:
- Previous studies have shown consolidation durvalumab improves progression-free and overall survival in patients with stage III NSCLC, but the optimal consolidation in EGFR-mutated disease remains less clear, especially since there is some evidence that immunotherapy can harm these patients.
- A retrospective study of 136 patients (median age, 66 years) with EGFR-mutated stage III NSCLC who were treated with concurrent chemoradiation followed by consolidation therapy with osimertinib, durvalumab, or observation between 2015 and 2022.
- The primary endpoint was real-world progression-free survival.
- The median follow-up time in the study was 46 months.
TAKEAWAY:
- Osimertinib prolonged real-world progression-free survival significantly compared with durvalumab (not reached vs 12.7 months; hazard ratio [HR], 0.20) or observation alone (not reached vs 9.7 months; HR, 0.67).
- There was no difference in the real-world progression-free survival between durvalumab and observation groups.
- Overall survival was similar across the three groups.
- The treatment-related adverse event rate was 52% in the osimertinib group and 48% in the durvalumab group. Grade 3 or above adverse event rate was higher with durvalumab (18%) than with osimertinib (6%).
IN PRACTICE:
The authors concluded that consolidation durvalumab does not provide clinical benefit in patients with EGFR-mutated NSCLC and "suggest consolidation osimertinib as a potential future standard of care."
SOURCE:
This study was led by Amir H. Nassar from Yale University School of Medicine, New Haven, Connecticut, and published online on January 24, 2024, in the Journal of Thoracic Oncology.
LIMITATIONS:
The limitations include retrospective design, selection bias in treatment decisions, uncontrolled timing of EGFR mutation testing in relation to consolidation therapy, and variable follow-up times leading to potential underestimation of treatment-related adverse events in the shorter follow-up cohort.
DISCLOSURES:
This study did not receive any funding. Many authors reported financial relationships with various organizations.