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ESMO 2025 | Elucidating the novel standard of care for EGFR-positive lung cancer
Sanjay Popat, MBBS, FRCP, PhD, Royal Marsden Hospital, London, UK, discusses the treatment approaches for patients with EGFR-positive lung cancer. Current approaches include osimertinib monotherapy, addition of chemotherapy to osimertinib assessed in the FLAURA2 trial (NCT04035486), and lazertinib with amivantamab assessed in the MARIPOSA study (NCT04487080). Prof. Popat emphasizes the importance of patient-centered decision-making, as osimertinib monotherapy is no longer considered the standard of care. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
So with patients with EGFR mutation positive lung cancer, we really have three approaches that we can now take for our patients with common EGFR mutations. We can stick to the standard, which is Osimertinib monotherapy, but we now have two randomized trials showing a strong and meaningful survival advantage. One is with the addition of chemotherapy to Osimertinib, the FLAURA2 trial, and the other is a biologically mediated approach with Lazertinib and Amivantamab, the MARIPOSA trial, the MARIPOSA 1 trial...
So with patients with EGFR mutation positive lung cancer, we really have three approaches that we can now take for our patients with common EGFR mutations. We can stick to the standard, which is Osimertinib monotherapy, but we now have two randomized trials showing a strong and meaningful survival advantage. One is with the addition of chemotherapy to Osimertinib, the FLAURA2 trial, and the other is a biologically mediated approach with Lazertinib and Amivantamab, the MARIPOSA trial, the MARIPOSA 1 trial. Now, in the MARIPOSA 1 trial, this is a very different mechanistic approach to improving survival because you’re effectively trying to reduce resistance and delaying resistance because we know that targeting MET is effective in delaying resistance. We know that from the resistance data that we have on these patients. And so you’re changing the natural history and the biology of this group of patients with that regimen. How do we select our patients is incredibly complex. And I don’t think that I have a quick soundbite for you, colleagues listening to this on that. But we need to think about which approach we have for the patients that’s in front of us. And I think at this stage, Osimertinib monotherapy is no longer standard of care as we have two trials demonstrating intensification of treatment improves survival. Now we need as oncologists not to be so paternalistic, bring our patients into the conversation, the discussion, have a discussion with them what their aims objectives are and then we’ll work out together what the right treatment cocktail for them is.
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