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FLAURA showed that starting with the third-generation EGFR drug osimertinib, rather than saving it for later, kept lung cancer under control for almost twice as long and helped people live longer.
FLAURA randomised 556 patients with untreated advanced non-small-cell lung cancer carrying an EGFR exon 19 deletion or L858R mutation to osimertinib or to a first-generation inhibitor, gefitinib or erlotinib. Osimertinib had been designed to hit the T790M resistance mutation and to spare wild-type EGFR, and the question was whether using it first beat using it after the older drugs failed.
Median progression-free survival was 18.9 months with osimertinib against 10.2 months with the comparator (hazard ratio 0.46), with fewer brain progressions and less rash and diarrhoea. The final analysis in 2020 showed median overall survival of 38.6 months against 31.8 months (hazard ratio 0.80), even though a third of the comparator arm crossed over to osimertinib.
The FDA approved osimertinib for first-line use in April 2018 and it became the standard against which FLAURA2 and MARIPOSA were later measured.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
556 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survivalprimary | Osimertinib | 279 | 18.9 months | 0.46 | - | link |
| Gefitinib or erlotinib | 277 | 10.2 months | ||||
| Overall survival | Osimertinib | 279 | 38.6 months | 0.8 | - | link |
| Gefitinib or erlotinib | 277 | 31.8 months |
One of the most cited trial reports Europe PMC returns for Osimertinib in Non-small-cell lung cancer, so it is a natural first reading for anyone weighing the idea it is linked from. The record was linked automatically by title and abstract; read the abstract above and the paper itself before relying on any figure.
Anyone diagnosed with advanced lung cancer should have EGFR testing before treatment, because osimertinib as the first drug gives the longest disease control, protects the brain, and is well tolerated. Chemotherapy is not the first step for these patients. The remaining questions are whether to intensify upfront (adding chemotherapy or amivantamab) and how to treat resistance when it develops.
Shares Suresh S. Ramalingam, Autonomous closed-loop adaptive therapy driven by blood tests and evolutionary models, Add the second drug on day one when the escape route is predictable, FLAURA: osimertinib as first treatment for EGFR-mutated lung cancer.
Shares Autonomous closed-loop adaptive therapy driven by blood tests and evolutionary models, Osimertinib, EGFR-mutated non-small-cell lung cancer, EGFR.
Shares Overall Survival with Osimertinib in Untreated, EGFR -Mutated Advanced NSCLC, FLAURA: osimertinib as first treatment for EGFR-mutated lung cancer, Osimertinib, EGFR-mutated non-small-cell lung cancer.
Shares Suresh S. Ramalingam, FLAURA: osimertinib as first treatment for EGFR-mutated lung cancer, Osimertinib, EGFR-mutated non-small-cell lung cancer.
Shares Autonomous closed-loop adaptive therapy driven by blood tests and evolutionary models, Osimertinib, EGFR-mutated non-small-cell lung cancer, AstraZeneca.
Shares LUX-Lung 3, Gefitinib, Erlotinib, Tyrosine kinase inhibitor (TKI).
Shares Overall Survival with Osimertinib in Untreated, EGFR -Mutated Advanced NSCLC, FLAURA: osimertinib as first treatment for EGFR-mutated lung cancer, Osimertinib, EGFR.
Shares ARCHER 1050, Gefitinib, EGFR-mutated non-small-cell lung cancer, EGFR.