Adjuvant osimertinib in NSCLC reduces risk of CNS recurrence

Patients with resectable non-small cell lung cancer (NSCLC) often develop (fatal) distant recurrences after surgery. A subgroup analysis of the ADAURA trial shows that osimertinib significantly decreases development of brain metastases.

Rates of disease recurrence after surgery and adjuvant chemotherapy remain high in patients with resectable NSCLC across disease stages and postoperative chemotherapy used. Distant recurrence, like CNS recurrence, are associated with poor prognosis. Recently, a first analysis of the phase 3 ADAURA trial demonstrated a highly significant and clinically meaningful improvement in disease-free survival (DFS) in patients with EGFR-mutated, resectable NSCLC (stage IB/II/IIIA) who were treated with adjuvant osimertinib (80 mg/day) until recurrence or for a maximum of 3 years [1].

Updated results showed that median DFS in patients (stage IB/II/IIIA) treated with osimertinib (n=339) was not yet reached versus 27.5 months in patients treated with placebo (n=343; HR 0.20; P<0.0001) [2]. In the osimertinib arm, 11% had an event (disease recurrence or death) at the time of cut-off versus 46% of patients in the placebo arm. In the osimertinib arm, recurrences were mostly local or regional (62%), whereas in the placebo arm the majority of recurrences were distant (61%). Of all patients treated with osimertinib, 1% developed an CNS recurrence versus 10% of all patients treated with placebo.

1. Herbst RS, et al. ASCO 2020, abstract LBA5.
2. Tsuboi M, et al. Osimertinib adjuvant therapy in patients (pts) with resected EGFR mutated (EGFRm) NSCLC (ADAURA): Central nervous system (CNS) disease recurrence. ESMO 2020 Virtual Meeting, abstract LBA1.

Posted on 25 November, 20204 September, 2023