Rajat Thawani, Assistant Professor at the Knight Cancer Institute at OHSU, shared on LinkedIn:
“EGFR NSCLC is becoming increasingly complex, and it is leading the pack among oncogenes.
First-line: osimertinib with platinum-pemetrexed (FLAURA2) is increasingly used. After progression, does it make sense to use more platinum-pemetrexed, now with amivantamab (MARIPOSA-2, median PFS 6.3 vs 4.2 months, HR 0.48) or, if FDA acts on Nov 14, ivonescimab (HARMONi, median PFS 6.8 vs 4.4 months, HR 0.52, any PD-L1)?
Open questions:
- Will these bispecifics have activity as a single agent? How many carboplatin-pemetrexed rechallenges should patients get?
- Do we stop pemetrexed at C4 to prevent cumulative toxicity, to keep it as an option later?
- Do we need a biomarker to choose between them (PD-L1, MET IHC)?
- How do we estimate survival benefit when the trial population came off FLAURA, but real-world patients now come off FLAURA2 or MARIPOSA?
- Will this happen in other oncogenes too? Is ALK next?
These are different trials and populations, with no head-to-head data. Practice will be sorted by access and toxicity before it is sorted by data. Lots more to come!”
You can also read: FLAURA2 Long-Term Safety: Toxicity Peaks Early With Osimertinib Plus Chemotherapy and Declines Over Time.
