Sheraz Azhar, Medical Oncology SpR at the University Hospitals of Leicester NHS Trust and Founder of OncsCare, shared a post on LinkedIn:
“LinkedIn Journal Club / Landamark Trial #2
Mariposa – as this regimen starts to enter UK clinical practice.
After FLAURA, first-line EGFR-mutant NSCLC felt “solved” for a while. MARIPOSA reopens the question — not by replacing osimertinib with another TKI, but by changing the strategy entirely.
By combining:
- A potent, CNS-active TKI (lazertinib)
- With a bispecific antibody targeting EGFR and MET (amivantamab)
Mariposa asks whether earlier, broader pathway blockade can delay resistance rather than chase it later.
The trial showed a clear PFS advantage over osimertinib, alongside improved CNS control – but with important trade-offs:
- Higher early toxicity burden
- A recognisable VTE risk, particularly in the first 4 months
- More complex delivery (IV + oral)
Crucially, practice is evolving:
- Subcutaneous Amivantamab has reduced chair time and infusion-related reactions
- Proactive VTE risk mitigation is now part of treatment planning
It’s also important to be clear about what we don’t yet have. There is no direct head-to-head comparison between MARIPOSA and FLAURA2, and overall survival data for MARIPOSA are still immature. As so often in oncology, we’re being asked to make strategy decisions in the absence of perfect comparative evidence – weighing PFS, CNS control, toxicity, and service delivery rather than waiting for a single definitive answer.
This isn’t a one-size-fits-all replacement for osimertinib – but it does force us to think carefully about patient selection, service delivery, and shared decision-making as this moves into routine care.
Questions for MDT discussion:
- Who is your ideal MARIPOSA patient?
- Would you choose this over osimertinib upfront today?
- Does subcutaneous delivery and planned VTE prophylaxis change your threshold to use it?
- How much complexity is acceptable without mature OS data?
Interested to hear perspectives from registrars and consultants.
Educational discussion only – not clinical advice.
Follow for weekly landmark trials in oncology.”
Other articles featuring Sheraz Azhar.
