In patients with EGFR mutant L858R stage III NSCLC who are unresectable due to multistation N2 disease, would you consider upfront osimertinib over definitive intent CCRT?

Topics: Lung Cancer • Radiation Oncology • Thoracic Malignancies • Medical Oncology • MD Anderson • NCI-CCC Tumor Board Question • Non-small cell lung cancer • NCI-CCC Thoracic Tumor Board Question

If CCRT is pursued, would you move forward with durvalumab consolidation? Assume the patient with ECOG PS 0 and no co-morbidities. How might this change if ECOG 2?

Answer from: Medical Oncologist at Academic Institution

This is a very complex question that is common among our thoracic tumor board discussions. I'll answer the latter question first. In this case, I would not offer consolidative durvalumab.There are data that immune checkpoint inhibitors (ICIs) have minimal to no benefit in the metastatic setting base...

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Medical Oncologist at NYU Winthrop Hospital
Great discussion

Medical Oncologist at Cancer Care Specialists/Renown Oncology/UNR
LAURA ‘overwhelmingly’ positive for PF...

Answer from: Radiation Oncologist at Community Practice

While we await LAURA results, I wanted to point out this recent multi-institutional retrospective analysis by Nassar et al., PMID 38278303. This analysis of 136 concurrent chemo-RT patients with stage III NSCLC suggests longer PFS in those receiving consolidative osimertinib compared to durvalumab o...

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Radiation Oncologist at Vanderbilt-Ingram Cancer Center
In regards to the LAURA trial - Consolidati...

Radiation Oncologist at UCLA | VA Greater Los Angeles Healthcare System
I have news for you. The Osi arm gets indefinite t...

Radiation Oncologist at Vanderbilt-Ingram Cancer Center
Interesting approach. Then, I would hope and expe...

Answer from: Radiation Oncologist at Academic Institution

I thoroughly enjoyed the above discussion points! One more obvious, but important point that I will add is that all patients eventually progress while on EGFR TKIs. These are not curative therapies. Patients who have EGFR-mutated Stages I-III, and even the oligometastatic Stage IV NSCLC, are potenti...

Answer from: Radiation Oncologist at Academic Institution

There have been multiple answers in regards to the role of consolidative osimeritinib as per above which, I think some shared decision-making and feasibility of approval is not unreasonable as above until we have LAURA results.In regards to the first question about considering induction osimeritinib...

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