Introduction
Non-small-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations is a prevalent subtype associated with specific targeted therapies. Despite initial responsiveness, resistance mechanisms often develop, necessitating novel treatment strategies. Recently, the combination of amivantamab, a bispecific antibody targeting EGFR and MET, with lazertinib, a third-generation EGFR tyrosine kinase inhibitor, has emerged as a promising approach, especially in untreated cases.
Study Background and Rationale
Previous clinical trials demonstrated that the combination of amivantamab and lazertinib substantially improved progression-free survival (PFS) compared to osimertinib in EGFR-mutant NSCLC. While median PFS benefits were clear, data on overall survival (OS)—a critical endpoint—remained pending. This phase 3 trial aimed to evaluate whether these PFS improvements translated into meaningful OS benefits, thereby shaping future treatment paradigms.
Study Design and Methods
This randomized, controlled phase 3 trial enrolled patients with previously untreated, locally advanced or metastatic NSCLC harboring common EGFR mutations (exon 19 deletion or L858R substitution). Participants were randomized in a 2:2:1 ratio to receive either the combination of amivantamab-lazertinib, osimertinib alone, or lazertinib alone.
Primary endpoints included progression-free survival and overall survival (from randomization to death from any cause). Additional assessments encompassed safety and tolerability. The median follow-up period was approximately 37.8 months, providing robust longitudinal data.
Key Findings and Results
The study enrolled 1074 patients: 429 in each of the combination and osimertinib arms, and 216 in the lazertinib arm. Noteworthy results include:
– The median overall survival was significantly longer with amivantamab-lazertinib than with osimertinib (hazard ratio [HR], 0.75; 95% CI, 0.61 to 0.92; P=0.005). The 3-year OS rate was 60% versus 51%, respectively.
– At the clinical cutoff, 38% of patients on the combination therapy remained on treatment, compared to 28% on osimertinib, indicating sustained disease control.
– Median PFS analysis showed a notable prolongation with the combination (23.7 months vs. 16.6 months; HR, 0.70; P<0.001).
– Response rates were comparable (~86%), but the duration of response improved significantly with combination therapy (median duration 25.8 months vs. 16.8 months).
Regarding safety, adverse events of grade 3 or higher occurred more frequently with amivantamab-lazertinib (80%) than with osimertinib (52%). Common toxicities included skin rash, venous thromboembolism, infusion-related reactions, which aligned with the known safety profiles. Importantly, no new safety signals emerged during extended follow-up.
Clinical Significance and Limitations
The demonstrated OS benefit with amivantamab-lazertinib underscores its potential as a frontline therapy for EGFR-mutated NSCLC. The increased incidence of high-grade adverse events warrants careful patient selection and management but does not negate its survival advantage.
While the results are compelling, limitations include potential selection biases and the generalizability to diverse patient populations. Further real-world studies and biomarker analyses could refine patient stratification and optimize outcomes.
Conclusion
This trial confirms that combining amivantamab with lazertinib offers a significant survival benefit over osimertinib in untreated EGFR-mutant NSCLC, endorsing this strategy as a new standard of care. Nonetheless, balancing efficacy with toxicity remains vital, emphasizing the importance of personalized treatment planning.
Funding and Trial Information
Funded by Janssen Research and Development, the trial is registered at ClinicalTrials.gov (NCT04487080) and reflects a pivotal advancement in targeted lung cancer therapy.
References
Yang JC, Lu S, Hayashi H, et al. Overall Survival with Amivantamab-Lazertinib in EGFR-Mutated Advanced NSCLC. N Engl J Med. 2025; 391:1486-1498.
Cho BC, Lu S, Felip E, et al. Amivantamab plus Lazertinib in Previously Untreated EGFR-Mutated Advanced NSCLC. N Engl J Med. 2024; 391: 1486-1498.
