Who this is for
If you have EGFR-mutated lung cancer and have been told about newer treatment approaches — including combining targeted therapy with chemotherapy — this is for you.
Why this question matters
For many years, osimertinib alone has been the standard first treatment.
It is effective, well tolerated, and allows many patients to live several years.
But the question is simple:
Can we improve outcomes further?
The newer approach: combination treatment
The FLAURA2 study looked at combining:
• Osimertinib (targeted therapy)
• With chemotherapy (platinum + pemetrexed)
This is a more intensive starting approach.
What the updated results show
In FLAURA2:
• Median overall survival approximately 47.5 months
• Compared to ~37–38 months with osimertinib alone
• Hazard ratio for death: ~0.77
This suggests a further improvement in survival.
In simple terms:
Survival is now approaching 4 years on average in selected patients.
How to interpret this carefully
This is where clinical judgment matters.
Not every patient needs combination treatment.
Factors that influence the decision include:
• Disease burden (how much cancer is present)
• Symptoms and pace of disease
• Patient fitness and tolerance
• Patient preference
For some patients, osimertinib alone remains entirely appropriate.
For others, starting with combination treatment may offer additional benefit. Cost is toxicity and logistics as chemotherapy is intravenous.
What this means for patients
This is not about replacing one standard with another overnight.
It is about having more than one good option and choosing carefully.
For patients in Melbourne, and for those in Sri Lanka, the Philippines, Indonesia, and the Maldives seeking coordinated second opinions, this is where experienced interpretation becomes critical.
The data does not make the decision —
the data informs the decision.
A simple way to understand the shift
Ten years ago:
• Survival often measured in months
Now:
• Osimertinib alone → ~3+ years median survival
• Combination approach → approaching 4 years in selected patients
And importantly — this continues to evolve.
Key Takeaway
• Osimertinib remains a highly effective and well-tolerated first-line treatment.
• Newer data suggests that adding chemotherapy may extend survival further in selected patients.
• The best approach depends on careful, individualised decision-making — not a one-size-fits-all strategy.
Key Evidence
1. Ramalingam SS, Vansteenkiste J, Planchard D, et al. Overall survival with osimertinib in untreated EGFR-mutated NSCLC. N Engl J Med. 2020;382(1):41-50.
2. Jänne PA, Planchard D, Cheng Y, et al. Osimertinib with or without chemotherapy in EGFR-mutated advanced NSCLC. N Engl J Med. 2023;389(25):2335-2348. doi:10.1056/NEJMoa2305947
3. Planchard D, et al. Overall survival from the FLAURA2 study: Osimertinib plus chemotherapy vs osimertinib monotherapy in EGFR-mutated advanced NSCLC. Presented at: IASLC 2024 World Conference on Lung Cancer; September 7-10, 2024; San Diego, CA. (Note: The 7.1-month OS trend was first majorly detailed in late 2024).