ADAURA: Osimertinib in Resected EGFR-Mutated NSCLC

EP: 1.Patient Profile: A 60-Year-Old Woman with Early-Stage Non–Small Cell Lung Cancer

EP: 2.NSCLC: Initial Impressions of Patient Profile and Biomarker Testing Practices

EP: 3.Treating Patients With Non–Small Cell Lung Cancer

EP: 4.Mechanism of Action of EGFR Inhibitors in NSCLC

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EP: 5.ADAURA: Osimertinib in Resected EGFR-Mutated NSCLC

EP: 6.Unmet Needs and Future Directions in Non–Small Cell Lung Cancer

Case: A 60-Year-Old Woman with Early-Stage Non–Small Cell Lung Cancer

Initial presentation and Clinical Workup

• Healthy 60-year-old Caucasian woman, 45 pack-year smoker, presented with a nonproductive cough
  • Physical exam revealed ECOG PS 0, BP: 120/93, HR: 74 bpm, BMI: 22
  • Pulm: lungs CTA bilaterally
  • Chest X-Ray: 5.5-cm right mass in right upper lobe
  • CT chest/abdomen: lobulated 5.5 x 5.1-cm mass in right upper lobe
  • Biopsy of Right Upper Lobe: adenocarcinoma, TTF1 (+) consistent with NSCLC
  • Labs are WNL; PET Imaging: negative for any lymph nodes or distant metastasis; Brain MRI: negative; PFTs: Normal

Treatment 

• Mediastinoscopy with negative lymph nodes on frozen section, followed by right upper lobectomy without complications
• Current ECOG PS remains 0
• Histopathology reveals 5.5-cm tumor with negative margins; 0 nodes positive for malignancy (2R, 4R, 7, and 11R are all negative)
• Patient is diagnosed with stage IIA (pT3N0M0) lung adenocarcinoma
• Molecular testing shows EGFR exon (19del) and PD-L1 expression of 40%.
• Post operation, the patient completes 4 cycles of adjuvant chemotherapy with cisplatin + pemetrexed. Her ECOG PS is 1.
• Patient begins treatment with osimertinib. 20 months after initiating osimertinib, the patient reports headaches and worsening fatigue.
• CT scans revealed 3 new liver lesions and Brain MRI visualized 1 new lesion.

This is a video synopsis/summary of a Case-Based Peer Perspectives featuring Sandip P. Patel, MD.

The ADAURA trial demonstrated that adjuvant osimertinib after surgery and chemotherapy significantly improves disease-free and overall survival in early-stage EGFR-mutant non–small cell lung cancer (NSCLC). Over 3 years of osimertinib decreased the risk of disease recurrence/death without concerning new safety signals.

For all NSCLC patients including early-stage cases, Patel obtains PD-L1, EGFR mutation, and ALK fusion testing to help guide optimal treatment. In this EGFR exon 19 deletion–positive case with high PD-L1 expression, he notes PD-L1 testing alone could be misleading, as immune checkpoint blockade is not appropriate following osimertinib and increases pneumonitis risk. With an actionable EGFR mutation in localized disease, his approach after lung surgery would be adjuvant cisplatin/pemetrexed chemotherapy for 4 cycles, then osimertinib for 3 years per ADAURA.

For disease progression after 2 years on osimertinib with new liver and brain metastases, he advocates biopsy of new lesions to assess histology, additional targetable alterations, and guide next-line therapy, including consideration of stereotactic radiosurgery.

Video synopsis is AI-generated and reviewed by Targeted Oncology™ editorial staff.