Tagrisso (Osimertinib) After Chemoradiotherapy in Stage III EGFR-Mutated Non-Small Cell Lung Cancer: What the LAURA Trial Showed
The New England Journal of Medicine has published the results of the LAURA trial in patients with unresectable stage III non-small cell lung cancer with an EGFR mutation who had not progressed after chemoradiotherapy. The trial compared Tagrisso (osimertinib) with placebo as consolidation therapy. Tagrisso produced a very pronounced benefit in progression-free survival.
In brief: what happened
A total of 216 patients were randomized: 143 received Tagrisso and 73 received placebo.
- Median progression-free survival was 39.1 months versus 5.6 months.
- 74% of patients on Tagrisso and 22% on placebo lived a year without progression.
- Overall survival data are still immature: 36-month overall survival was 84% versus 74%, HR 0.81.
Key numbers from the trial
Tagrisso (osimertinib) reduced the risk of progression or death by 84%: HR 0.16; 95% CI 0.10–0.24; p<0.001. Grade 3 and higher adverse events were observed in 35% of patients on osimertinib and in 12% on placebo. Radiation pneumonitis, mostly grade 1–2, was reported in 48% and 38% respectively.
Why this matters in practice
Before LAURA, patients with EGFR-mutated stage III unresectable NSCLC after chemoradiotherapy had no targeted consolidation this strong with a convincing PFS benefit. For practice, this means that after completing the chemoradiotherapy stage it is now critical to know the molecular status of the tumor.
Limitations / what does not change yet
These data do not apply to operable lung cancer and do not apply to metastatic disease. The key condition is the presence of an EGFR mutation and no progression after completing chemoradiotherapy. Overall survival data are still immature.
When a second opinion is especially useful
- you were not offered molecular testing after chemoradiotherapy;
- there is an EGFR mutation, but further strategy was not discussed;
- you are offered observation only and want to understand whether it is justified;
- the balance of benefit and toxicity needs to be assessed.
What to prepare for the consultation
To make the review focused:
- histopathology report;
- EGFR molecular testing results;
- chemoradiotherapy protocols;
- CT or PET-CT after completion of treatment;
- blood test results and a description of comorbidities;
- list of current medications.
Frequently Asked Questions
Is Tagrisso suitable for all patients after chemoradiotherapy?
No. Only patients with unresectable stage III NSCLC, an EGFR mutation and no progression after chemoradiotherapy.
Is this already a proven improvement in overall survival?
Overall survival data are still immature. The main convincing benefit was achieved in progression-free survival.
If EGFR testing was not done, does it matter?
Yes. After LAURA, knowing the EGFR status becomes essential for choosing consolidation therapy.
More answers on the FAQ page.