Neoadjuvant Osimertinib for Resectable EGFR -Mutated Non-Small-Cell Lung Cancer

PURPOSE Adjuvant osimertinib is standard-of-care for patients with resected epidermal growth factor receptor ( EGFR )-mutated non–small-cell lung cancer (NSCLC). Neoadjuvant treatment could improve surgical and long-term outcomes. METHODS In this randomized, controlled, phase 3 study, patients with resectable, EGFR -mutated, stage II–IIIB NSCLC were randomly assigned (1:1:1) to receive neoadjuvant osimertinib (80 mg orally once daily for ≥9 weeks) plus platinum-based chemotherapy (every 3 weeks for three cycles), osimertinib monotherapy (for ≥9 weeks), or placebo plus platinum-based chemotherapy (control), followed by surgical resection. Adjuvant osimertinib was offered to eligible patients after completion of surgery. The primary endpoint was major pathological response (MPR) by blinded central pathology review. Event-free survival (EFS) was a secondary endpoint. RESULTS Overall, 358 patients were randomized to receive osimertinib-plus-chemotherapy (121 patients), osimertinib-monotherapy (117 patients), or placebo-plus-chemotherapy (120 patients). Osimertinib-plus-chemotherapy (MPR rate 26%) and osimertinib-monotherapy (25%) demonstrated statistically significant improvement in the MPR rate versus placebo-plus-chemotherapy (2%), with corresponding odds ratios of 19.82 (95.002% confidence interval [CI], 4.60, 85.33; p<0.0001) and 19.28 (99.9% CI, 1.71, 217.39; p<0.0001), respectively. With 15% data maturity, the EFS rates at 12 months were 93%, 95%, and 83% with osimertinib-plus-chemotherapy, osimertinib-monotherapy, and placebo-plus-chemotherapy, respectively. In the neoadjuvant period, grade ≥3 adverse events of any cause occurred in 36%, 13%, and 33% of patients with osimertinib-plus-chemotherapy, osimertinib-monotherapy, and placebo-plus-chemotherapy, respectively. No new safety concerns were identified. CONCLUSION Neoadjuvant osimertinib with or without chemotherapy demonstrated statistically significant improvement in the MPR rate over chemotherapy alone in patients with resectable, EGFR -mutated, stage II–IIIB NSCLC.