Updates from MARIPOSA Trial in EGFR+ NSCLC

EP: 1.Patient Profile: A 73-Year-Old Man with EGFR+ NSCLC

EP: 2.Overview of Treatment Options for EGFR+ NSCLC

EP: 3.EGFR+ NSCLC: Recent Data From FLAURA2

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EP: 4.Updates from MARIPOSA Trial in EGFR+ NSCLC

EP: 5.Treatment Decision-Making for Patients With EGFR+ NSCLC

EP: 6.PAPILLON: Amivantamab Plus Chemotherapy in Patients With NSCLC Positive for EGFR Mutations

EP: 7.Key Takeaways on Treating Patients With EGFR+ NSCLC

Case: A 73-Year-Old Man with EGFR+ NSCLC

Clinical Presentation:

• 73-year-old man initially presents with complaints of a persistent nonproductive cough, dyspnea on mild exertion, and an unintentional 10 lb. weight loss over prior 3 months

Past Medical History:

• Coronary Artery Disease: treated with rosuvastatin 20 mg QD.
• Hypertension, controlled on ARB QD.
• Hyperlipidemia, treated with atorvastatin 20 mg QD.
• COPD, maintained on triple inhalation therapy BID.

Social History:

• Retired high school teacher; married with 2 adult children.
• 50 pack-year smoking history: quit tobacco habit 5 years previously

Initial Clinical Workup and Diagnosis:

Physical Examination

• Ambulatory but no longer drives and is capable of self-care without assistance.
• Height: 5’10”; Weight:78 kg (172 lbs.)
• ECOG PS: 1
• Diminished breath sounds auscultated over right upper lobe.

Pulmonary Function Tests

• FEV1 2.1 L (68% predicted) indicative of moderate obstruction.

Imaging Studies:

• Chest CT: showed a 4.2 x 3.1 cm spiculated mass in the right upper lobe with suspected hilar lymph node involvement.
• PET Scan: confirms hypermetabolic right hilar and subcarinal lymph nodes activity suggestive of malignancy.
• MRI of Abdomen and Brain and Tech99 Bone Scintigraphy: no evidence of metastases.

Diagnostic Procedure:

• Bronchoscopy with Biopsy: gross appearance of specimen obtained from right upper lobe consistent with adenocarcinoma of the lung.
  • Histopathology: confirms lung adenocarcinoma (Grade 2; pT2b pN1 [2/17 lymph nodes positive]; V0 R0), with partially papillary and partially tubular morphology.

Neoadjuvant Therapy and Surgical Resection:

• Patient receives 4 cycles of cisplatin + pembrolizumab + pemetrexed.
• He tolerated the regimen well with manageable episodes of fatigue, nausea, and sporadic neuropathy of the bilateral upper extremities.
• Post-Treatment Restaging PET Scan: showed a good partial response.
• Surgical Resection:
  • Lobectomy of the RUL with hilar and mediastinal lymphadenectomy via video-assisted thoracoscopic surgery (VATS).

Surgical Pathology Report:

• ypT2aN1 (3/16 lymph nodes positive) with negative margins; Stage IIa
  • Adjuvant RT was recommended, but the patient declined.

Six Months Later:

• Patient returns to his oncologist with complaints of recurrent, mid-to-low back pain.
• Post-Operative Chest CT: displays scattered pulmonary nodules suspicious for metastatic disease progression.
• Thoraco-lumbar MRI: negative for bony metastases.

Second Line Systemic Therapy:

• Amivantamab was initiated with a weekly, weight-based infusion x4w(split dose, Days 1-2, Week 1), and thereafter q2w.
• The patient developed a minor infusion reaction on day 1 of therapy, which resolved with application of cool compresses to the site and acetaminophen, 500 mg PO q4h, prn.

Repeat Imaging at 8 Weeks:

• The patient experienced a good partial response.
  • He will continue to be followed regularly by his oncologist.

This is a video synopsis/summary of a Case-Based Peer Perspectives featuring Joshua K. Sabari, MD.

This video features a discussion on the recent phase 3 MARIPOSA trial results of the antibody-drug conjugate amivantamab plus the third-generation EGFR tyrosine kinase inhibitor lazertinib for the first-line treatment of EGFR-mutated non–small cell lung cancer (NSCLC). The trial compared amivantamab-lazertinib to osimertinib monotherapy and lazertinib monotherapy.

The amivantamab-lazertinib combination demonstrated nearly a 24-month median progression-free survival benefit over 16-17 months with osimertinib. Toxicities were manageable but increased, including more skin rash, venous thromboembolism requiring anticoagulation, and infusion reactions with amivantamab plus lazertinib.

Overall survival data is still immature, but a hazard ratio of 0.8 suggests potential for sustained benefit. Routine brain MRI was done and removing central nervous system progressions extended median progression-free survival to 28 to 29 months with the amivantamab-lazertinib combination.

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