Loading
The first regimen to beat osimertinib in EGFR-mutant lung cancer, with a survival benefit exceeding a year.
MARIPOSA, trial NCT04487080 sponsored by Johnson & Johnson and published in the New England Journal of Medicine in 2024, produced the first regimen to beat osimertinib in first-line EGFR-mutant non-small-cell lung cancer, with a survival benefit exceeding a year. It randomised 1,074 patients to amivantamab plus lazertinib or osimertinib, met its primary progression-free survival endpoint by blinded review and showed an overall survival benefit in 2025, at the cost of venous thromboembolism needing prophylaxis and skin toxicity needing management. Whether the survival gain justifies the added toxicity for every patient is the open question.
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.
1,074 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survival (BICR)primary | Amivantamab + lazertinib | 429 | 23.7 months | 0.7 (0.58 to 0.85) | <0.001 | link |
| Osimertinib | 429 | 16.6 months | ||||
| Overall survival | Amivantamab + lazertinib | - | Median not reached | 0.75 (0.61 to 0.92) | 0.005 | link |
| Osimertinib | - | 36.7 months |
Patients newly diagnosed with EGFR-mutated advanced lung cancer now have a first-line option that improves survival over osimertinib, particularly if they have high-risk features. The trade-off is intravenous (now subcutaneous) infusions and considerably more skin, nail and clotting toxicity, so osimertinib alone remains reasonable for those who prioritise convenience and tolerability. Both this regimen and osimertinib plus chemotherapy (FLAURA2) are approved; there is no direct comparison.
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 Lazertinib, Amivantamab, Johnson & Johnson, Bispecific antibodies.
Shares Lazertinib, Amivantamab, Johnson & Johnson, Bispecific antibodies.
Shares Lazertinib, Amivantamab, Johnson & Johnson, Bispecific antibodies.
Shares Lazertinib, Amivantamab, Johnson & Johnson, Bispecific antibodies.
Shares Lazertinib, Amivantamab, Johnson & Johnson, Bispecific antibodies.
Shares Lazertinib, Amivantamab, Johnson & Johnson, Bispecific antibodies.
Shares Add the second drug on day one when the escape route is predictable, MARIPOSA: amivantamab plus lazertinib versus osimertinib as first treatment for EGFR-mutated lung cancer, FLAURA: osimertinib as first treatment for EGFR-mutated lung cancer, Targeted therapy roadmap: imatinib → designed for resistance → the undruggable drivers fall.
Shares Amivantamab + lazertinib (first-line EGFR NSCLC), Amivantamab, MET, Acquired resistance to every therapy.