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Shaping the Future of Stage 3 EGFR-Mutated NSCLC: Your Voice Matters

Thank you for participating in this survey.

Before you begin, please take a moment to read the brochure provided. It contains important background information that will help you understand the context and purpose of this survey.

Background

The treatment landscape for patients with stage III non-small cell lung cancer (NSCLC) has evolved rapidly. The landmark PACIFIC trial established a new standard of care by demonstrating improved progression-free survival (PFS) and overall survival (OS) with consolidation durvalumab for 1 year in patients with unresectable locally advanced NSCLC who did not progress after chemoradiotherapy (CRT)1, 2. However, post-hoc analysis and real-world data have showed that the benefits of using Durvalumab do not extend to patients with NSCLC harbouring common sensitizing EGFR mutations3, 4.

Recently, two phase III trials, LAURA and POLESTAR, demonstrated significant improvements in PFS with third-generation EGFR tyrosine kinase inhibitors (osimertinib and aumolertinib) until disease progression or death, compared with placebo when used as consolidation therapy following CRT in patients with unresectable locally advanced EGFR-mutant NSCLC5, 6.

However, interpretation of these results must be approached with caution, given several important considerations:
  • Baseline staging limitations: FDG-PET was not mandated in the LAURA and POLESTAR trials, and the timeframe between staging and commencement of therapy was up to 6 months. in LAURA trial, only 55% (Osimertinib arm) and 45% (placebo arm) of patients underwent baseline FDG-PET5. According to an independent neuroradiology review, 10% and 7% of patients in the Osimertinib and placebo arms had central nervous system (CNS) metastases at baseline7.
  • Inconsistent radiotherapy quality: Approximately a quarter of patients received non-radical radiation doses5. Radiation therapy quality assurance and collection of detailed radiotherapy data are lacking.
  • Underperforming control arms: The placebo arms of LAURA and POLESTAR trials reported median PFS of 5.9 and 3.8 months, respectively, which were lower than historical benchmarks, such as PACIFIC (10.9 months in the subgroup of EGFR-mutated tumours)3 and real-world data (12.7 months)4. In the FLAURA trial, patients with stage IV EGFR-mutated NSCLC receiving first-line Osimertinib achieved a median PFS of 18.9 months8. These discrepancies raise concerns about the robustness of the observed comparative benefit in the experimental arms.
  • Immature OS data: The interim analysis of the LAURA trial showed no significant OS benefit, with 36-month OS rates of 84% vs 74% in the osimertinib and placebo groups (hazard ratio, 0.83)5. There was a high crossover rate of 81% from the placebo group receiving osimertinib upon disease progression. An updated OS analysis from the LAURA trial, presented at the European Lung Cancer Congress 2025, reported a favourable trend toward osimertinib, with a hazard ratio of 0.67. Further mature OS data adjusted for crossover are awaited.
References
  1. Antonia SJ, Villegas A, Daniel D, et al. Durvalumab after chemoradiotherapy in stage III non-small cell lung cancer. N Engl J Med. 2017
  2. Spigel DR, Faivre-Finn C, Gray JE, et al. Five-year overall survival from the PACIFIC trial: Durvalumab after chemoradiotherapy in stage III non-small cell lung cancer. N Engl J Med. 2022
  3. Naidoo J, Antonia Scott, Wu YL, et al. Brief report: Durvalumab after chemoradiotherapy in unresectable stage III EGFR-mutant NSCLC: A post hoc subgroup analysis from PACIFIC. J Thorac Oncol. 2023
  4. Nassar AH, Kim SY, Aredo JV, et al. Consolidation osimertinib versus durvalumab versus observation after concurrent chemoradiation in unresectable EGFR-mutant NSCLC: A multicenter retrospective cohort study. J Thorac Oncol. 2024
  5. Lu S, Kato T, Dong X, et al. Osimertinib after chemoradiotherapy in stage III EGFR-mutated NSCLC. N Engl J Med. 2024
  6. Meng X, Ge H, Ning F, et al. Aumolertinib after chemoradiotherapy in unresectable stage III non-small cell lung cancer with EGFR mutation: interim analysis of the phase III POLESTAR study. Presented at 2024 IASLC World Conference on Lung Cancer; 2024, San Diego. Abstract PL04.13
  7. Lu S, Ahn MJ, Reungwetwattana, et al. Osimertinib after definitive chemoradiotherapy in unresectable stage III epidermal growth factor receptor-mutated non-small-cell lung cancer: analyses of central nervous system efficacy and distant progression from the phase III LAURA study. Ann Oncol. 2024
  8. Soria JC, Ohe Y, Vansteenkiste J, et al. Osimertinib in untreated EGFR-mutated advanced non-small-cell lung cancer. N Engl J Med. 2017
Purpose of the Survey

In light of emerging data and ongoing uncertainties, this survey aims to capture clinician perspectives on the role of consolidation EGFR-TKIs following curative-intent chemoradiotherapy in patients with unresectable locally advanced stage III EGFR-mutant NSCLC.

Your insights will help inform future research priorities, guiding clinical trial design, and informing potential updates on practice recommendations.

Instructions
  • This survey is completely voluntary and anonymous. No personal data will be collected.
  • This survey will take approximately 10-15 minutes to complete.
  • Please select only one option for each question, unless otherwise specified.
  • When the question refers to “in this setting”', it specifically refers to unresectable locally advanced stage III EGFR-mutated NSCLC.
KEY AREA 1: DEMOGRAPHICS
1.Which country/ region are you from?
https://countrycode.org
2.What is your medical specialty?
3.For how many years have you been in clinical practice as a specialist?
4.How often are you involved in the management of patients with unresectable locally advanced EGFR-mutated NSCLC?
KEY AREA 2: PATTERN OF PRACTICE IN STAGING AND MOLECULAR TESTING
5.In your current practice, do you routinely obtain a baseline FDG PET-CT for staging in patients with unresectable locally advanced NSCLC who are eligible for curative-intent treatment?
6.In the absence of financial and logistic constraints, would you routinely obtain a baseline FDG PET-CT for staging in patients with unresectable locally advanced NSCLC who are eligible for curative-intent treatment?
7.In your current practice, what is an acceptable time interval between PET-CT and treatment initiation in this setting?
8.In your current practice, do you routinely obtain a baseline MRI brain for staging in patients with unresectable locally advanced NSCLC who are eligible for curative-intent treatment?
9.In the absence of financial and logistic constraints, would you routinely obtain MRI brain for staging in patients with unresectable locally advanced NSCLC who are eligible for curative-intent treatment?
10.In your current practice, do you routinely obtain an endobronchial ultrasound (EBUS)-guided mediastinal lymph node sampling for staging in patients with unresectable locally advanced NSCLC who are eligible for curative-intent treatment?
11.In the absence of financial and logistic constraints, would you routinely obtain an endobronchial ultrasound (EBUS)-guided mediastinal lymph node sampling for staging in patients with unresectable locally advanced NSCLC who are eligible for curative-intent treatment?
12.In your current practice, do you routinely obtain programmed death ligand 1 (PD-L1) tumour proportion score (TPS) testing in patients with unresectable locally advanced NSCLC?
13.In your current practice, do you routinely obtain whole-panel next-generation sequencing (NGS) testing in patients with unresectable locally advanced NSCLC?
14.In your current practice, do you routinely obtain molecular testing for EGFR-sensitizing mutations in patients with unresectable locally advanced NSCLC?
15.Is molecular testing for EGFR-sensitizing mutations funded at the centre where you practice?
16.At your current centre, how do you test for EGFR-mutations? Please select all that apply.
17.What is the estimated turnaround time for molecular testing for EGFR-sensitizing mutations at the centre where you practice?
KEY AREA 3: PATTERN OF PRACTICE IN TREATMENT
18.Are you a clinician involved in prescribing systemic therapy and/ or radiotherapy?
19.In your routine clinical practice, what is your current treatment approach for patients with unresectable locally advanced EGFR-mutated NSCLC and good performance status (e.g. ECOG 0-1) who are eligible for curative-intent treatment and have no contraindications to chemoradiotherapy?
20.In the absence of financial and logistic constraints, what would be your current treatment approach for patients with unresectable locally advanced EGFR-mutated NSCLC and good performance status (e.g. ECOG 0-1) who are eligible for curative-intent treatment and have no contraindications to chemoradiotherapy?
21.Are you a clinician involved in prescribing systemic therapies?
22.In your current practice, do you routinely prescribe an EGFR tyrosine kinase inhibitor to patients with unresectable locally advanced EGFR-mutated NSCLC who do not progress after curative-intent chemoradiotherapy?
23.Which EGFR tyrosine kinase inhibitor agent do you use in this setting?
24.What are your main reasons of not prescribing EGFR tyrosine kinase inhibitor in this setting? Please select up to three options.
25.Do you routinely prescribe Durvalumab for patients with unresectable locally advanced EGFR-mutated NSCLC who do not progress after curative-intent chemoradiotherapy?
26.Are you a clinician involved in prescribing radiation therapy?
27.Does your centre have a formal quality assurance process for radiation therapy?
Note: quality assurance may include, but is not limited to, peer review of volume delineation and/ or radiation plans, patient-specific quality assurance, machine-specific quality assurance.
28.Which radiation techniques do you routinely use for delivering curative-intent radiation therapy in this setting? Please select all that apply.
29.In your current practice, for patients with good performance status (e.g. ECOG 0-1), which is your preferred RT dose fractionation for patients with unresectable locally advanced EGFR-mutated NSCLC planned for concurrent chemoradiotherapy?
30.In the absence of financial and logistic constraints, for patients with good performance status (e.g. ECOG 0-1), which would be your preferred RT dose fractionation for patients unresectable locally advanced EGFR-mutated NSCLC planned for concurrent chemoradiotherapy?
KEY AREA 4: PERSPECTIVES ON FUTURE TRIALS
31.Do you have any concerns about using EGFR tyrosine kinase inhibitors indefinitely in this setting?
32.What are your main concerns relating to the indefinite use of EGFR tyrosine kinase inhibitors? Please select up to three options.
33.Would you be interested in a clinical trial evaluating treatment strategy optimisation in this setting of patients with unresectable locally advanced EGFR-mutated NSCLC?
34.What treatment strategies do you consider most appropriate to investigate in a clinical trial for patients with unresectable locally advanced EGFR-mutated NSCLC? Please select up to three options.
35.What should be the primary endpoint of a study aiming to optimise treatment strategies in patients with unresectable locally advanced EGFR-mutated NSCLC?
36.Would you be willing to enrol patients in a clinical trial aiming to optimise treatment strategies in patients with unresectable locally advanced EGFR-mutated NSCLC?
You have reached the end of the survey.
Thank you once again for your time and contributions.