FLAURA2: Should this Positive Trial Change Practice for EGFRm+ NSCLC

The FLAURA2 trial, discussed by oncologist Jack West, focused on comparing treatment options for EGFR mutation-positive non-small cell lung cancer (NSCLC) patients. This highly anticipated study compared Osimertinib as a single agent to Osimertinib combined with chemotherapy in a randomized trial involving 557 patients


Jack West, MD is an associate professor in medical oncology specializing in thoracic oncology at the City of Hope Comprehensive Cancer Center in the Los Angeles area. Recently, he discussed the highly anticipated FLAURA2 trial during the World Conference on Lung Cancer in Singapore. In his words, "Hi, I'm Jack West. I'd like to talk about the FLAURA2 trial, which was among the most anticipated presentations at the just completed World Conference on Lung Cancer in Singapore."

The FLAURA2 trial aimed to compare the efficacy of Osimertinib as a single agent versus Osimertinib combined with chemotherapy as a first-line treatment for patients with EGFR mutation-positive non-small cell lung cancer. The chemotherapy regimens included cisplatin or carboplatin with pemetrexed. A total of 557 patients were randomized in a 1-to-1 ratio between the single-agent and combination therapy groups.

Jack West noted, "What we saw was an improvement in progression-free survival, statistically significant and probably clinically significant as well, with a hazard ratio of 0.62." However, he also pointed out some discrepancies in the progression-free survival data between investigator assessment and blinded review, particularly in the monotherapy arm.

Regarding overall survival, Jack West mentioned that the results were still immature, with only 27 percent data maturity, and the survival curves did not show significant differences.

The discussion then turned to the trade-offs of combining chemotherapy with Osimertinib, such as increased toxicity rates, including myelosuppression, fatigue, and nausea. Jack West highlighted that while the combination therapy improved progression-free survival, it came at the cost of more side effects and a longer treatment duration.

Jack West concluded by expressing his reservations about adopting this approach for all patients, emphasizing that for many, sequential treatment tailored to individual needs might be a better strategy. He suggested that intensification with chemotherapy might be considered for selected patients, especially those with higher-risk disease or specific mutations.

In summary, the FLAURA2 trial results showed an improvement in progression-free survival with Osimertinib combined with chemotherapy, but the decision to adopt this approach should be carefully considered based on individual patient characteristics and preferences. Jack West encouraged a thoughtful approach to treatment decisions in EGFR mutation-positive non-small cell lung cancer.