Do the results and approval based on ADAURA trial suggest a role for adjuvant osimertinib in patients with stage IIIB-C, EGFR mutant patients treated with concurrent chemoradiation?

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Medical Oncology · University of Maryland

Answered on

ADAURA trial was not designed to address this issue. But that being said, we need to remember few things before considering "maintenance durvalumab" in patients with EGFR-mutant lung cancer, following chemo-radiation:

1. EGFR-mutant NSCLC patients may not derive any clinical benefit from single-agent maintenance durvalumab.

2. Stage IIIB-IIIC NSCLC has a high risk of disease recurrence/relapse. And the favored treatment option at that time is osimertinib. But, we have seen that PD-L1 blockade followed by osimertinib can be associated with severe immune related toxicity unless we delay the treatment by few months, which is not always possible.

LAURA trial (NCT03521154) is actually investigating the role of osimertinib in this setting. This ...

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Medical Oncology · University of Colorado Cancer Center

Answered on

The ADAURA trial did not address this issue and similarly, the Pacific trial did not address whether patients with driver alterations should receive durvalumab after CT/RT. It is certainly highly likely that adjuvant osimertinib would increase DFS but uncertain whether it would improve overall survival and cure rates. This should be addressed directly in clinical trials. Certainly, it is worth discussing 3 years of adjuvant osimertinib with patients to determine their preference. Another issue to be addressed in future trials is whether ctDNA tests should be done with those that are negative not treated while those who still have detectable ctDNA offered therapy.

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