Tagrisso (osimertinib) + chemotherapy as first-line for EGFR-mutated advanced lung cancer: final FLAURA2 results

In 2026, the final overall survival analysis of the FLAURA2 trial was published for patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) harboring EGFR mutations. The trial compared Tagrisso (osimertinib) in combination with platinum-pemetrexed chemotherapy versus Tagrisso monotherapy as first-line treatment.

Trial results

Patients were randomized 1:1 to Tagrisso (osimertinib) + platinum/pemetrexed or to Tagrisso (osimertinib) alone.

• Median overall survival was 47.5 months on the combination vs 37.6 months on monotherapy
• This is a highly significant difference for first-line EGFR-mutated advanced NSCLC
• The benefit was observed on top of the previously established progression-free survival advantage
• The European Society for Medical Oncology (ESMO) emphasized that the data support the use of the combination as a first-line option

Clinical significance

For EGFR-mutated advanced lung cancer, the central question for a long time has been: is osimertinib alone sufficient, or should treatment be intensified from the start? The final FLAURA2 data provide an answer to this question.

We now see that the combination of Tagrisso (osimertinib) with platinum and pemetrexed can deliver not only longer disease control but also longer overall survival, meaning longer life. This is a full-fledged treatment option at the start of therapy.

Limitations

The trial applies specifically to advanced disease with classic activating EGFR mutations -- exon 19 deletion or L858R. The combination inevitably carries a greater toxicity and logistical burden than single-agent targeted therapy alone.

The choice between monotherapy and the combination still requires consideration of potential complications, disease volume, comorbidities, and the patient's readiness for a more intensive first-line regimen.

When a second opinion is helpful

• If an EGFR mutation has been found and first-line treatment is currently being selected
• If you are being offered osimertinib alone without discussion of the combination
• If the disease is symptomatic, high-volume, or rapidly progressing
• If you need to understand whether intensifying the first line is justified in your specific situation

What to prepare for consultation

• Histopathology report
• EGFR molecular testing results
• CT scans of the chest and other affected areas
• Brain MRI, if performed
• Complete blood count and biochemistry panel
• List of comorbidities and current medications

Frequently asked questions

Source

ESMO: First-line treatment with osimertinib plus platinum-pemetrexed prolongs OS