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Clinical Trials & Efficacy - FLAURA

Logo for Tagrisso (osimertinib) which is coloured lime teal and purple and shaped like lungs

Clinical Trials & Efficacy: FLAURA

FLAURA was a global Phase III study designed to investigate first-line
TAGRISSO in patients with locally advanced or metastatic EGFRm NSCLC.1–3

Efficacy

Clinical trial design

Study population

Clinical trial endpoints

Safety profile

TAGRISSO efficacy: OS and PFS improvement vs comparator EGFR TKI3,4

As a first-line treatment for advanced EGFRm NSCLC, TAGRISSO significantly improved OS and PFS vs comparator EGFR-TKIs.3,4

mPFS

18.9 months vs 10.2 months with gefitinib/erlotinib

 

HR=0.46 (95% CI: 0.37–0.57; P<0.0001)3

Primary endpoint

mOS

38.6 months vs 31.8 months with gefitinib/erlotinib

 

HR=0.799 (95% CI: 0.641–0.997; P=0.0462)4

Secondary endpoint

In advanced EGFRm NSCLC, patients treated with first-line TAGRISSO remained progression-free for a median of 18.9 months1–3

Statistically significant PFS1,2
Primary endpoint

Graph showing the primary endpoint PFS in patients with EGFRm NSCLC in FLAURA trial

Adapted from TAGRISSO (osimertinib) 40 mg and 80 mg Summary of Product Characteristics.1,2

CI, confidence interval; HR, hazard ratio; PFS, progression-free survival

Patients experienced the efficacy of TAGRISSO as early as 6 weeks (time of first assessment).1–3

In advanced EGFRm NSCLC, patients survived for a median of 6.8 months longer when treated with first-line TAGRISSO vs gefitinib/erlotinib1,2,4

Statistically significant OS1,2
Prespecified secondary endpoint

Graph showing the primary endpoint OS in patients with EGFRm NSCLC in FLAURA trial

Adapted from TAGRISSO (osimertinib) 40 mg and 80 mg Summary of Product Characteristics.1,2

*PFS was the primary endpoint. OS was a prespecified secondary endpoint; statistically significant HR for OS was demonstrated (HR=0.799; 95.05% CI: 0.641–0.997; P=0.0462).1,2,4

CI, confidence interval; HR, hazard ratio; PFS, progression-free survival; OS, overall survival

Prespecified exploratory analysis

Patients were approximately half as likely to develop new CNS metastases with TAGRISSO compared to gefitinib/erlotinib (RRR=52%, ARR at 18 months=18%; HR=0.48; 95% CI: 0.26–0.86, P=0.014).*5

  • CNS lesions are difficult to treat, as many are unresectable, and systemic chemotherapy has limited efficacy6
  • Progression due to new CNS lesions was 12% (7 of 61 patients) for first-line TAGRISSO vs 30% (20 of 67 patients) for gefitinib/erlotinib*5
  • TAGRISSO was more effective at reducing the size of existing CNS metastases than gefitinib/erlotinib (median best percentage change from baseline in CNS evaluable for response set, TAGRISSO -64% vs gefitinib/erlotinib -45%)5
FLAURA: CNS PFS in patients with CNS metastases at baseline*5
Graph showing CNS PFS in patients with EGFRm NSCLC in FLAURA trial Graph showing CNS PFS in patients with EGFRm NSCLC in FLAURA trial

Adapted from Reungwetwattana T et al. 2018.5

*CNS PFS was measured per blinded independent central review. Patients with asymptomatic or stable CNS metastases were eligible. Patients with symptomatic/unstable CNS metastases were permitted if stable for ≥2 weeks after completion of definitive therapy and corticosteroids.5

ARR, absolute risk reduction; CNS, central nervous system; HR, hazard ratio; PFS, progression-free survival

Clinical trial design chart for FLAURA trial - global phase 3 randomised TAGRISSO vs EGFR-TKI comparator Clinical trial design chart for FLAURA trial - global phase 3 randomised TAGRISSO vs EGFR-TKI comparator

Tumour assessments were performed at baseline, every 6 weeks for 18 months, and then every 12 weeks until disease progression.5 Baseline brain imaging was mandated only in patients with known or suspected CNS metastases, with follow-up imaging with confirmed CNS metastases.5

Adapted from Soria JC et al. N Engl J Med 2018.3

*Investigator’s choice of comparator.

EGFRm, epidermal growth factor receptor mutant; NSCLC, non-small cell lung cancer; TKI, tyrosine kinase inhibitor

Baseline characteristics were well balanced across study arms.3

Characteristics TAGRISSO (n=279)Placebo (n=277)
Age (years)
Median
6464
Range
26–8535–93
Sex
Male36%38%
Female––
Race
White
36%36%
Asian
62%62%
Other1%1%
Smoking status
Never
65%63%
Current
3%3%
Former32%34%
WHO performance status040%42%
160%58%
MetastasesVisceral metastases
32%34%
CNS metastases*
35%34%
EGFRm type at randomisation*
Exon 19 deletion
63%63%
L858R
37%37%
EGFRm type by central test*
Exon 19 deletion
55%34%
Asian
3%62%
No mutation detected, invalid
test or no or inadequate sample
45%34%

 

Adapted from Soria JC et al. N Engl J Med 2018.3

*Patients with asymptomatic or stable CNS metastases were eligible. Patients with symptomatic/unstable CNS metastases were permitted if stable for ≥2 weeks after completion of definitive therapy and corticosteroids.7

†A patient could have more than one type of mutation.3

CNS, central nervous system; EGFRm, epidermal growth factor receptor mutant; L858R, exon 21 substitution; WHO, World Health Organization

Primary endpoint: PFS by investigator assessment (RECIST v1.1).1,2
Secondary endpoints: included OS, CNS PFS, ORR, DoR, DCR, safety in EGFRm (ex19del or L858R) NSCLC.3,5
Crossover to second-line TAGRISSO was allowed for patients (EGFRm status- exon 19 deletion or L858R) in the gefitinib/erlotinib arm upon centrally confirmed disease progression with confirmed EGFR T790M mutation.4

Explore TAGRISSO’s results

Navigate the safety profile: FLAURA trial

Explore safety profile

Take a closer look at how TAGRISSO is administered: FLAURA trial

Explore dosing and administration

Learn more about how TAGRISSO works

Explore MOA

ARR, absolute risk reduction; CI, confidence interval; CNS, central nervous system; DCR, disease control rate; DFS, disease-free survival; DoR, duration of response; EGFR, epidermal growth factor receptor; EGFRm, epidermal growth factor receptor mutant; HR, hazard ratio; L858R, exon 21 substitution; MOA, mode of action; mOS, median overall survival; mPFS, median progression-free survival; NC, not calculated; NR, not reached; NSCLC, non-small cell lung cancer; ORR, overall response rate; OS, overall survival; PFS, progression-free survival; RRR, relative risk reduction; TKI, tyrosine kinase inhibitor

 

  1. TAGRISSO (osimertinib) 40 mg Summary of Product Characteristics.
  2. TAGRISSO (osimertinib) 80 mg Summary of Product Characteristics.
  3. Soria JC, Ohe Y, Vansteenkiste J, Reungwetwattana T, Chewaskulyong B, Lee KH, et al. Osimertinib in Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer. N Engl J Med. 2018 Jan 11;378(2):113-25.
  4. Ramalingam SS, Vansteenkiste J, Planchard D, Cho BC, Gray JE, Ohe Y, et al. Overall Survival with Osimertinib in Untreated, EGFR-Mutated Advanced NSCLC. N Engl J Med. 2020 Jan 2;382(1):41-50.
  5. Reungwetwattana T, Nakagawa K, Cho BC, Cobo M, Cho EK, Bertolini A, et al. CNS Response to Osimertinib Versus Standard Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Patients With Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer. J Clin Oncol. 2018 Aug 28:JCO2018783118.
  6. Colclough N, Chen K, Johnström P, et al. Preclinical comparison of the blood-brain barrier permeability of osimertinib with other EGFR TKls. Clin Cancer Res. 2021;27(1):189-201.
  7. Soria JC, Ohe Y, Vansteenkiste J, Reungwetwattana T, Chewaskulyong B, Lee KH, et al. Osimertinib in Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer. (Protocol) N Engl J Med. 2018 Jan 11;378(2):113-25.

GB-63982 | DOP: July 2025

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