Targeted Cancer Drug Lowers Risk of Cancer Growth or Death in Lung Cancer with a Specific Mutation

A study has shown that giving patients with lung cancer a targeted therapy drug after combined chemotherapy and radiation therapy (chemoradiotherapy) helps them live longer without the cancer growing or spreading. The results of this study were presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting.  

“The phase 3 LAURA clinical trial is the first to demonstrate that personalized therapy can improve outcomes in patients with locally advanced non-small cell lung cancer (NSCLC),” said ASCO expert Charu Aggarwal, MD, MPH, FASCO, the Leslye M. Heisler Associate Professor of Medicine at the University of Pennsylvania.

Researchers for the LAURA study found that patients with stage III NSCLC who were treated with osimertinib (Tagrisso) after chemoradiotherapy had an 84% lower risk of cancer growth or death compared to those who received chemoradiotherapy and a placebo. The median progression-free survival (PFS) was about 3.5 years for people who received osimertinib. PFS is the amount of time after treatment begins where there is no new cancer growth or changes. In comparison, the median PFS in the placebo group was 6 months.

A common lung cancer mutation that complicates treatment

About 1 of every 3 people with stage III NSCLC that cannot be treated with surgery have changes to the EGFR gene. This type of change is called a genetic mutation. When NSCLC has an EGFR mutation, it is called EGFR-mutated NSCLC.

The current standard-of-care treatment for stage III NSCLC that cannot be treated with surgery is an immunotherapy drug called durvalumab (Imfinzi). It is given after chemoradiotherapy, which is a combination of chemotherapy and radiation therapy. However, durvalumab does not work well for patients who have changes to the EGFR gene.

To find another treatment option for this patient population, researchers turned to osimertinib, a targeted therapy drug. This type of cancer treatment targets the specific genes and proteins that help cancer cells survive and grow.  

Osimertinib is already approved by the U.S. Food and Drug Administration (FDA) to treat stage IV EGFR-mutated NSCLC and EGFR-mutated NSCLC that can be treated with surgery. Researchers hoped osimertinib could also help patients with stage III EGFR-mutated NSCLC that cannot be treated with surgery.

Osimertinib stops cancer growth over 2 years

After 1 year, 3 out of every 4 patients in the osimertinib group (74%) did not have any cancer growth. In comparison, about 1 out of every 5 patients in the placebo group (22%) did not have any cancer growth.

After 2 years, nearly 2 out of every 3 patients in the osimertinib group (65%) did not have any cancer growth. Over the same period, about 1 out of every 10 patients in the placebo group (13%) did not have any cancer growth.

“Osimertinib treatment after chemoradiation had a clinically meaningful benefit and significantly increased the time that patients were alive without the cancer growing or spreading, compared with chemoradiation and a placebo drug,” said lead study author Suresh Ramalingam, MD, FACP, FASCO, professor and executive director of the Winship Cancer Institute at Emory University. “We believe that osimertinib will become the new standard of care for patients.”

Osimertinib also helped stop the spread of cancer to the brain. In the osimertinib group, about 1 out of 10 patients (8%) had cancer that spread to the brain. In the placebo group, almost a third of patients (29%) had cancer that spread to the brain.

The most common side effect in both groups was radiation pneumonitis. Radiation pneumonitis is inflammation in the lungs caused by radiation therapy to the chest. Most cases were mild or moderate.

A new option for people with mutated lung cancer

The first EGFR-targeted drug was approved to treat metastatic NSCLC in 2004. Now 20 years later, the results from the LAURA study highlight how the development of targeted therapy has changed the course of treatment for lung cancer.

“The LAURA trial is the first to define the role of EGFR-directed therapy in unresectable stage III disease,” said David R. Spigel, MD, chief scientific officer of the Sarah Cannon Research Institute. “While the study did not compare osimertinib to the current standard-of-care immunotherapy, these data have major implications for both patients and oncologists and will change the standard of care for patients with EGFR mutations.” 

“This study also underscores the importance of molecular testing in how we choose treatments,” Dr. Aggarwal added. Molecular testing, also called biomarker testing, identifies the genes, proteins, and other factors in the tumor. This can help doctors better match each patient with the most effective treatment possible. Tailoring cancer treatment for the individual patient is called personalized therapy.

Talking about personalized treatment with your cancer care team

If you have NSCLC, talking with your cancer care team can help you understand more about your recommended treatment plan. Consider asking your doctor these questions:

• Does my cancer have an EGFR mutation?
• Can molecular testing help guide my treatment plan?
• Are there clinical trials that may be an option for me based on my molecular testing results?
• Will I receive more treatment after chemoradiotherapy?

Read a patient-friendly summary of this research.

Dr. Aggarwal is an Associate Editor on ASCO’s Patient Information Editorial Board.