Does osimertinib work

Does osimertinib work

For patients with advanced non-small cell lung cancer, the clinical value of osimertinib has been extensively validated.

Clinical trial data support

The global multi-center FLAURA study revealed:

• Median survival of treatment-naïve patients with EGFR-sensitive mutations was 38.6 months

• 54% reduction in risk of disease progression

• The incidence of grade 3 and above adverse reactions is lower than that of first-generation TKI drugs

The study covered 556 participants in 29 countries and was followed for more than four years.

Central nervous system penetration

Osimertinib has a significant control effect on brain metastases:

• 66% objective response rate in patients with parenchymal brain metastases

• Median intracranial progression-free survival was extended to 15.2 months

• The survival time of patients with meningeal metastases was improved to 18.9 weeks

Data from the BLOOM study published in the New England Journal of Medicine in 2021.

Treatment options after drug resistance

There are solutions for different mechanisms of resistance:

• EGFR C797S mutation with brigatinib combination regimen

• Capmatinib response rate increased to 40% in MET amplified patients

• Etoposide plus immunotherapy is recommended for small cell transformation cases

The 2023 ESMO guidelines have updated the relevant treatment pathways.

Key points of clinical practice application

Standardized use is the basis for maximizing the efficacy of drugs.

Genetic testing requirements

The following testing criteria must be met:

• Tissue sample testing confirms EGFR exon 19 deletion or L858R mutation

• Repeat tissue biopsy is required in cases of negative plasma ctDNA

• High-risk groups with TP53 co-mutations were excluded

Assays require the use of a certified next-generation sequencing technology platform.

Dose management practices

Dose adjustment regimen for special populations:

• Reduced to 40 mg/day for patients with Child-Pugh grade C liver function

• If there is a prolonged QTc interval> the medication should be discontinued for 500 ms

• The incidence of interstitial lung disease is controlled within 2.9%.

The FDA drug package insert clearly indicates the relevant management measures.

Advances in combination therapy

Exploring new treatment options includes:

• Combination of anti-angiogenic drugs to prolong the duration of drug resistance by 7.2 months

• Sequential stereotactic radiotherapy improves local control rate by 34%

• Neoadjuvant therapy achieved a pathological downstaging rate of 41%

These regimens are being validated in Phase III clinical studies.

Osimertinib has shown clear clinical value in the treatment of EGFR-mutant lung cancer, and its rational application should be based on accurate diagnosis and standardized management. The care team should develop an individualized treatment plan based on the latest evidence-based medical evidence.