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 mutations^{3, 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 NSCLC^{5, 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

Antonia SJ, Villegas A, Daniel D, et al. Durvalumab after chemoradiotherapy in stage III non-small cell lung cancer. N Engl J Med. 2017
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
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
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
Lu S, Kato T, Dong X, et al. Osimertinib after chemoradiotherapy in stage III EGFR-mutated NSCLC. N Engl J Med. 2024
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
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
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

Question Title

* 1. Which country/ region are you from?
https://countrycode.org

Question Title

* 2. What is your medical specialty?

Medical Oncology

Radiation Oncology

Clinical Oncology

Pulmonology or Respiratory Medicine

Other:

Question Title

* 3. For how many years have you been in clinical practice as a specialist?

< 5 years

5-10 years

11-15 years

16-20 years

> 20 years

Question Title

* 4. How often are you involved in the management of patients with unresectable locally advanced EGFR-mutated NSCLC?

Very frequently (> 10 patients per month)

Frequently (3-10 patients per month)

Occasionally (1-2 patients per month)

Rarely (a few cases per year)

KEY AREA 2: PATTERN OF PRACTICE IN STAGING AND MOLECULAR TESTING

Question Title

* 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?

Yes. Proceed to Question 7

No. Skip to Question 6

Question Title

* 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?

Yes. Proceed to Question 7

No. Skip to Question 8

Question Title

* 7. In your current practice, what is an acceptable time interval between PET-CT and treatment initiation in this setting?

Within 4 weeks

Within 6 weeks

Within 8 weeks

Other (please specify)

Question Title

* 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?

Yes. Proceed to Question 10

No. Proceed to Question 9

Question Title

* 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?

Yes

Question Title

* 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?

Yes. Proceed to Question 12

No. Proceed to Question 11

Question Title

* 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?

Yes

Question Title

* 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?

Yes

Question Title

* 13. In your current practice, do you routinely obtain whole-panel next-generation sequencing (NGS) testing in patients with unresectable locally advanced NSCLC?

Yes. Skip to Question 18

No. Proceed to Question 14

Question Title

* 14. In your current practice, do you routinely obtain molecular testing for EGFR-sensitizing mutations in patients with unresectable locally advanced NSCLC?

Yes. Proceed to Questions 15, 16 and 17

No. Skip to Question 18

Question Title

* 15. Is molecular testing for EGFR-sensitizing mutations funded at the centre where you practice?

Yes

Unsure

Question Title

* 16. At your current centre, how do you test for EGFR-mutations? Please select all that apply.

Tissue polymerase chain reaction (PCR)

Tissue next-generation sequencing (NGS)

Liquid PCR

Liquid NGS

Other (please specify)

Question Title

* 17. What is the estimated turnaround time for molecular testing for EGFR-sensitizing mutations at the centre where you practice?

1-3 days

4-7 days

8-14 days

> 14 days

KEY AREA 3: PATTERN OF PRACTICE IN TREATMENT

Question Title

* 18. Are you a clinician involved in prescribing systemic therapy and/ or radiotherapy?

Yes. Proceed to Question 19

No. This will mark the end of survey for the respondents who answer “No”

Question Title

* 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?

Concurrent chemoradiotherapy, followed by consolidation EGFR-TKI (if no evidence of disease progression)

Concurrent chemoradiotherapy, followed by consolidation Durvalumab (if no evidence of disease progression)

Concurrent chemoradiotherapy alone

Sequential chemotherapy, followed by radiotherapy, then consolidation EGFR-TKI (if no evidence of disease progression)

Sequential chemotherapy, followed by radiotherapy, then consolidation Durvalumab (if no progression)

Sequential chemotherapy, followed by radiotherapy

Neoadjuvant EGFR-TKI, followed by surgery

Neoadjuvant EGFR-TKI, followed by radiotherapy

Neoadjuvant EGFR-TKI, followed by chemoradiotherapy

EGFR-TKI alone

EGFR-TKI with concurrent chemotherapy

EGFR-TKI with concurrent Amivantamab

Other (please specify)

Question Title

* 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?

Concurrent chemoradiotherapy, followed by consolidation EGFR-TKI (if no evidence of disease progression)

Concurrent chemoradiotherapy, followed by consolidation Durvalumab (if no evidence of disease progression)

Concurrent chemoradiotherapy alone

Sequential chemotherapy, followed by radiotherapy, then consolidation EGFR-TKI (if no evidence of disease progression)

Sequential chemotherapy, followed by radiotherapy, then consolidation Durvalumab (if no progression)

Sequential chemotherapy, followed by radiotherapy

Neoadjuvant EGFR-TKI, followed by surgery

Neoadjuvant EGFR-TKI, followed by radiotherapy

Neoadjuvant EGFR-TKI, followed by chemoradiotherapy

EGFR-TKI alone

EGFR-TKI with concurrent chemotherapy

EGFR-TKI with concurrent Amivantamab

Other (please specify)

Question Title

* 21. Are you a clinician involved in prescribing systemic therapies?

Yes. Proceed to Question 22

No. Skip to Question 26

Question Title

* 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?

Yes. Proceed to Question 23

No. Proceed to Question 24

Other (please specify). Skip to Question 25

Question Title

* 23. Which EGFR tyrosine kinase inhibitor agent do you use in this setting?

Osimertinib

Aumolertinib

Gefitinib

Erlotinib

Afatinib

Dacomitinib

Other (please specify)

Question Title

* 24. What are your main reasons of not prescribing EGFR tyrosine kinase inhibitor in this setting? Please select up to three options.

Lack of mature overall survival data to date

Cost and reimbursement issues

Tolerability and safety profile concerns

Patient preference

EGFR tyrosine kinase inhibitor continued indefinitely

The need for long-term regular monitoring, which includes but is not limited to blood test and ECG

Lack of approval of indications by local guidelines

Unavailability of EGFR testing

Other (please specify)

Question Title

* 25. Do you routinely prescribe Durvalumab for patients with unresectable locally advanced EGFR-mutated NSCLC who do not progress after curative-intent chemoradiotherapy?

Yes

Other (please specify)

Question Title

* 26. Are you a clinician involved in prescribing radiation therapy?

Yes. Proceed to Question 27-30

No. Skip to Question 31

Question Title

* 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.

Yes

Unsure

Question Title

* 28. Which radiation techniques do you routinely use for delivering curative-intent radiation therapy in this setting? Please select all that apply.

3DCRT

IMRT

VMAT

Tomotherapy

Proton therapy

MR-Linac

Other (please specify)

Question Title

* 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?

60-66 Gy in 30-33 fractions

50-55 Gy in 20 fractions

60Gy in 15 fractions

Other (please specify)

Question Title

* 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?

60-66 Gy in 30-33 fractions

50-55 Gy in 20 fractions

60Gy in 15 fractions

Other (please specify)

KEY AREA 4: PERSPECTIVES ON FUTURE TRIALS

Question Title

* 31. Do you have any concerns about using EGFR tyrosine kinase inhibitors indefinitely in this setting?

Yes. Proceed to Question 32

No. Skip to Question 33

Question Title

* 32. What are your main concerns relating to the indefinite use of EGFR tyrosine kinase inhibitors? Please select up to three options.

Potential long-term toxicity

Cost and financial burden

Risk of development of resistance to EGFR-TKI

Risk of exhausting future effective treatment

Compliance issues

Impact on quality of life

Lack of mature overall survival data to date

Lack of data on late toxicity

Other (please specify)

Question Title

* 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?

Yes. Proceed with Question 34, 35, 36

No. This marks the end of the survey for the respondents who answer “No”

Unsure. This marks the end of the survey for the respondents who answer “Unsure”

Question Title

* 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.

Timing of EGFR-TKI: delayed versus immediate EGFR-TKI following chemoradiotherapy

Duration of EGFR-TKI: fixed-duration versus indefinite-duration

EGFR -TKI dosing schedules: intermittent versus continuous

EGFR -TKI dosing regimen: reduced dose versus standard dose

Sequencing of EGFR-TKI: neoadjuvant EGFR TKI followed by chemoradiotherapy versus concurrent chemoradiotherapy followed by consolidation EGFR TKI

Biomarker-driven approach: risk stratification based on measurable residual disease (MRD) using circulating tumour DNA (ctDNA)

Radiotherapy dose: de-escalated radiation dose versus standard radiation dose, in the context of concurrent chemoradiotherapy followed by consolidation EGFR-TKI

Other (please specify)

Question Title

* 35. What should be the primary endpoint of a study aiming to optimise treatment strategies in patients with unresectable locally advanced EGFR-mutated NSCLC?

Progression-free survival

Overall survival

Central nervous system metastasis

Quality of life

Treatment-related adverse events

Cost-effectiveness

Other (please specify)

Question Title

* 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?

Yes

Unsure

You have reached the end of the survey.

Thank you once again for your time and contributions.

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

Question Title

* 1. Which country/ region are you from?https://countrycode.org

Question Title

* 2. What is your medical specialty?

Question Title

* 3. For how many years have you been in clinical practice as a specialist?

Question Title

* 4. How often are you involved in the management of patients with unresectable locally advanced EGFR-mutated NSCLC?

Question Title

* 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?

Question Title

* 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?

Question Title

* 7. In your current practice, what is an acceptable time interval between PET-CT and treatment initiation in this setting?

Question Title

* 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?

Question Title

* 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?

Question Title

* 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?

Question Title

* 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?

Question Title

* 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?

Question Title

* 13. In your current practice, do you routinely obtain whole-panel next-generation sequencing (NGS) testing in patients with unresectable locally advanced NSCLC?

Question Title

* 14. In your current practice, do you routinely obtain molecular testing for EGFR-sensitizing mutations in patients with unresectable locally advanced NSCLC?

Question Title

* 15. Is molecular testing for EGFR-sensitizing mutations funded at the centre where you practice?

Question Title

* 16. At your current centre, how do you test for EGFR-mutations? Please select all that apply.

Question Title

* 17. What is the estimated turnaround time for molecular testing for EGFR-sensitizing mutations at the centre where you practice?

Question Title

* 18. Are you a clinician involved in prescribing systemic therapy and/ or radiotherapy?

Question Title

* 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?

Question Title

Question Title

* 21. Are you a clinician involved in prescribing systemic therapies?

Question Title

* 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?

Question Title

* 23. Which EGFR tyrosine kinase inhibitor agent do you use in this setting?

Question Title

* 24. What are your main reasons of not prescribing EGFR tyrosine kinase inhibitor in this setting? Please select up to three options.

Question Title

* 25. Do you routinely prescribe Durvalumab for patients with unresectable locally advanced EGFR-mutated NSCLC who do not progress after curative-intent chemoradiotherapy?

Question Title

* 26. Are you a clinician involved in prescribing radiation therapy?

Question Title

* 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.

Question Title

* 28. Which radiation techniques do you routinely use for delivering curative-intent radiation therapy in this setting? Please select all that apply.

Question Title

* 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?

Question Title

* 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?

Question Title

* 31. Do you have any concerns about using EGFR tyrosine kinase inhibitors indefinitely in this setting?

Question Title

* 32. What are your main concerns relating to the indefinite use of EGFR tyrosine kinase inhibitors? Please select up to three options.

Question Title

* 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?

Question Title

* 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.

Question Title

* 35. What should be the primary endpoint of a study aiming to optimise treatment strategies in patients with unresectable locally advanced EGFR-mutated NSCLC?

Question Title

* 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?

* 1. Which country/ region are you from?
https://countrycode.org

* 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.