The LAURA trial, which evaluated osimertinib’s effect in patients with unresectable Stage III EGFR-mutant non-small cell lung cancer who received chemoradiotherapy (CRT), was presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting. The results were also concurrently published in NEJM.

#
The LAURA trial evaluated progression-free survival (PFS) in 216 patients with unresectable stage III EGFR-mutant NSCLC who received chemoradiotherapy (CRT). The patients were randomized to receive osimertinib or placebo.

The results showed a median PFS of 39.1 months and 5.6 months in the osimertinib and placebo arms, respectively, with an 84% reduction in the risk of disease progression and death in the osimertinib arm. The overwhelming numbers were met with spontaneous resounding ovation.

Although the overall survival rates were not clear yet, researchers also added a positive interpretation based on the fact that overall survival did show a clear trend toward improved survival in the osimertinib arm, even though 80% of the placebo arm switched to osimertinib.

Professor Suresh S. Ramalingam from the Winship Cancer Institute at Emory University School of Medicine, who presented results of the phase III LAURA study during the Plenary Session at the 2024 ASCO Annual Meeting, said, “The current standard of care for unresectable stage III EGFR-mutant NSCLC patients following CRT is durvalumab, but the benefit of the immunotherapy agent, specifically among patients with EGFR mutations, is uncertain. Based on the clear benefits, osimertinib after CRT will most likely emerge as the new standard of care for EGFR-mutant disease in this setting.”

The next big question will be in setting the eligible subjects and timing of administration.

Patients with unresectable stage III EGFR-mutant NSCLC who have received chemoradiotherapy (CRT) are regarded as an incurable group of patients, who have a high likelihood of relapse in the future. This is why drug use in this patient group needs to be reviewed from various aspects.

Professor Lecia V. Sequist from the Massachusetts General Hospital and Harvard Medical School, who attended the presentation as a discussant for the abstract, regarded the results as a half glass of water, explaining that osimertinib may and may not be a viable treatment option depending on the perspective.”

He emphasized that the positive benefits of osimertinib in terms of preventing brain metastases are a clear advantage, but the cost of the drug and increased side effects are a disadvantage.

Professor Beung-Chul Ahn of the National Cancer Center, said, "The positive outcome of osimertinib in this group of patients is very welcome evidence, but if we evaluate it soberly, the cost of the drug cannot be ignored in clinical practice, and there are groups of patients who do not necessarily need it, so we need a treatment strategy that reviews its use according to the situation.”