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Recent data from FLAURA2 confirms overall survival benefit for osimertinib plus chemotherapy in newly diagnosed EGFR-positive NSCLC. Four thoracic oncologists discuss shifting treatment paradigms and patient selection strategies.
⚕️ Key Clinical Considerations ⚕️
- Overall survival confirmed: FLAURA2 demonstrates significant survival advantage with osimertinib-chemotherapy combination versus osimertinib alone in treatment-naive patients.
- Treatment selection complexity: Clinicians now evaluate reasons to deescalate to monotherapy rather than intensify, considering patient fitness, preferences, and lifestyle factors.
- Chemotherapy duration matters: Benefit correlates with longer pemetrexed exposure (≥12 months), suggesting maintenance continuation rather than induction-only approaches.
- Post-progression options: Ivonescimab shows PFS improvement in osimertinib-resistant disease but survival data remains immature.
🎯 Clinical Practice Impact 🎯
- The conversation has shifted from finding reasons to intensify treatment to identifying patients who need deescalation.
- Combination therapy becomes the starting point, with monotherapy reserved for patients with significant comorbidities, limited support systems, or strong preference against chemotherapy.
- Extended clinic visits are now standard to discuss multiple regimen options and align treatment complexity with patient priorities.
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