How to Choose the Best First-Line Therapy for Patients With EGFR-Mutated NSCLC
Key Points
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Three main treatment options for EGFR-mutated non-small cell lung cancer (NSCLC): osimertinib monotherapy, osimertinib plus chemotherapy, or amivantamab plus lazertinib.
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Amivantamab plus lazertinib showed significant improvements in progression-free survival and overall survival.
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80% of patients have high-risk NSCLC, which supports combination therapy.
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Expert panel explores optimal treatment for patients with brain metastases.
The current treatment landscape for patients with non-small cell lung cancer (NSCLC) who have EGFR mutations consists of 3 options: the use of osimertinib alone, osimertinib combined with chemotherapy, or the combination of amivantamab plus lazertinib. Each regimen has demonstrated significant improvements in progression-free survival and overall survival.
At the 2025 American Society of Clinical Oncology Annual Meeting, a panel of experts, led by Rahul Gosain, MD, MBA, and Rohit Gosain, MD, broke down key considerations for best therapy selection based on their real-world experiences.
For patients who have low-risk disease and need a quick response, osimertinib alone, a third-generation tyrosine kinase inhibitor (TKI), may be suitable. In contrast, for patients with central nervous system involvement, particularly brain metastases, the panel leaned toward a more intensive regimen, such as amivantamab plus lazertinib, a bispecific antibody and TKI combination therapy, respectively.
Other patient factors, such as cytopenias or inability to take anticoagulants, also influence treatment decisions. Patient preference may play a role, too. For instance, a patient’s wish for oral versus infusion therapy or a chemotherapy-free regimen.
For patients and providers, shared decision-making remains crucial to help find the right treatment without compromising efficacy and quality of life.