CONFERENCE UPDATE: ESMO 2025
Osimertinib + plat-pem shows consistent OS benefits in EGFRm advanced NSCLC irrespective of poor baseline prognostic factors: Exploratory OS analyses from FLAURA2
STUDY DESIGN
In the phase 3 FLAURA2 study, osimertinib + platinum-pemetrexed (plat-pem) demonstrated statistically significant improvements in progression-free survival (PFS) and overall survival (OS) vs. osimertinib monotherapy in epidermal growth factor receptor-mutated (EGFRm) advanced non-small cell lung cancer (NSCLC), achieving a median OS of 47.5 months.1 These findings, along with a manageable safety profile, establish osimertinib + plat-pem combination as a recommended first-line treatment for EGFRm advanced NSCLC.1 Prior studies in EGFRm NSCLC have identified baseline factors associated with poorer prognosis, including L858R mutation (vs. Ex19del), presence of central nervous system (CNS), liver or bone metastases, TP53 alterations, and detectable plasma EGFRm circulating tumor DNA (ctDNA).1 The captioned analyses hence analyzed OS outcomes in FLAURA2 based on baseline prognostic factors.1
FLAURA2 was a global, randomized, open-label phase 3 study enrolling 557 patients with untreated, locally advanced or metastatic EGFRm non-squamous NSCLC.1 Eligible patients were aged ≥18 years, had pathologically confirmed EGFR Ex19del or L858R mutations, a World Health Organization Performance Status (WHO-PS) of 0 or 1, and underwent mandatory baseline CNS imaging, with stable CNS metastases allowed.1 Patients were stratified by race, the type of EGFR mutation test used, and WHO-PS prior to randomization.1
Patients were randomized 1:1 to receive osimertinib 80mg once daily (QD) alone, or osimertinib 80mg QD + pemetrexed 500mg/m² with either cisplatin or carboplatin.1 Radiological assessments were performed at week 6 and 12, then every 12 weeks until disease progression, with survival follow-up every 12 weeks until the data cut-off for the planned final OS analysis.1 The proportion of patients in each prognostic subgroup was generally balanced across treatment arms.1
At the ESMO Congress 2025, results from the exploratory OS analyses were presented, focusing on key baseline prognostic factors, including L858R mutation, CNS, liver, or bone metastases, TP53 alterations, and detectable plasma EGFRm ctDNA.1

FINDINGS
| Exploratory outcomes: |
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“Survival benefit consistently favored osimertinib + plat-pem vs. monotherapy regardless of baseline prognostic factors, reinforcing its first-line use as standard of care in EGFRm advanced NSCLC.”
Dr. Pasi A. Jänne
Dana-Farber Cancer Institute,
Boston, United States