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ESMO 2020: CNS Recurrence Patterns With Osimertinib in Treatment of NSCLC

By: Julia Fiederlein
Posted: Tuesday, October 6, 2020

In the phase III ADAURA trial, patients with resected stage IB to IIIA EGFR-mutated non–small cell lung cancer (NSCLC) appeared to derive a statistically significant and clinically meaningful central nervous system (CNS) disease-free survival benefit from treatment with the third-generation EGFR tyrosine kinase inhibitor osimertinib. Masahiro Tsuboi, MD, PhD, of the National Cancer Center Hospital East, Kashiwa, Japan, and colleagues reported an 82% reduction in the risk of CNS disease recurrence of death with osimertinib during the Presidential Symposium at the European Society for Medical Oncology (ESMO) Virtual Congress 2020 (Abstract LBA1).

“In the resected EGFR-mutated NSCLC setting, the impact of treatment on sites of recurrence, including the central nervous system, is a key consideration,” the investigators commented. “Results support that osimertinib reduces the risk of central nervous system recurrence [in this patient population].”

In a 1:1 allocation ratio, a total of 682 patients with resected stage IB to IIIA EGFR-mutated NSCLC were randomly assigned to receive 80 mg of osimertinib daily (n = 339) or a placebo (n = 343). To be enrolled, the patients were required to have undergone an MRI or CT brain scan at baseline; however, it was not mandatory in the absence of symptoms. Local/regional and distant sites of relapse were recorded.

Treatment with osimertinib resulted in fewer CNS recurrence events (1% vs. 10%), disease-free survival events (11% vs. 46%), and non-CNS (10% vs. 36%) recurrence events than treatment with the placebo. CNS disease-free survival events were observed in 45 patients. The conditional probability of CNS recurrence at 12 months was higher with the placebo (7%) than with osimertinib (less than 1%). The median CNS disease-free survival was 48.2 months with the placebo; however, it was not reached with osimertinib. According to the investigators, treatment with osimertinib resulted in an 82% reduction in the risk of CNS recurrence or death.

Disclosure: For full disclosures of the study authors, visit oncologypro.esmo.org.



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