COMPARATIVE EFFECTIVENESS OF CONSOLIDATION DURVALUMAB VERSUS OSIMERTINIB IN PATIENTS WITH UNRESECTABLE, STAGE III, EGFR-MUTATED NON-SMALL-CELL LUNG CANCER: A SYSTEMATIC REVIEW
Author(s)
Sunny Park, PharmD, Joseph S. Chang, MS, Xiaomo (Shawn) Xiong, PhD;
University of Cincinnati, Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, Cincinnati, OH, USA
University of Cincinnati, Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, Cincinnati, OH, USA
OBJECTIVES: The comparative effectiveness of consolidation therapies for unresectable stage III EGFR-mutated non-small cell lung cancer (NSCLC) remains uncertain. This systematic review compared consolidation durvalumab versus osimertinib with respect to progression-free survival (PFS).
METHODS: Following the PRISMA framework, PubMed and Embase were systematically searched through May 2025 for studies of stage III NSCLC, EGFR mutations, durvalumab, and osimertinib. Eligible studies included clinical trials or observational studies of adults with unresectable stage III EGFR-mutated NSCLC receiving consolidation durvalumab or osimertinib after chemoradiotherapy. Primary outcomes were PFS. Two independent reviewers screened records in Covidence. Of 160 records identified, 37 underwent full-text review and 5 met inclusion criteria.
RESULTS: Five studies (2 randomized controlled trials and 3 observational studies) contributed six unique PFS comparisons, as one randomized trial (LAURA) reported PFS by both blinded independent central review and investigator assessment. Sample sizes ranged from 35 patients (PACIFIC EGFR-mutant subgroup) to 216 patients (LAURA), with median ages in the mid-60s and predominance of exon 19 deletions and L858R mutations.
Consolidation osimertinib demonstrated substantial efficacy in the phase 3 LAURA trial, with an observed median PFS of 39.1 months by blinded independent central review (hazard ratio [HR] 0.16; 95% CI 0.10-0.24) and 38.9 months by investigator assessment (HR 0.19; 95% CI, 0.12-0.29), compared with 5.6 and 7.3 months for placebo, respectively.
Consolidation durvalumab showed variable benefit across studies, with observed median PFS ranging from 10.3 to 17.5 months. While one real-world cohort reported improved PFS versus chemoradiotherapy alone, other studies showed no statistically significant improvement over observation or placebo. Across studies, durvalumab PFS estimates remained shorter than those observed with osimertinib.
CONCLUSIONS: Consolidation osimertinib is associated with a longer observed median PFS than consolidation durvalumab in patients with unresectable, stage III, EGFR-mutated NSCLC, supporting osimertinib as preferred consolidation therapy.
METHODS: Following the PRISMA framework, PubMed and Embase were systematically searched through May 2025 for studies of stage III NSCLC, EGFR mutations, durvalumab, and osimertinib. Eligible studies included clinical trials or observational studies of adults with unresectable stage III EGFR-mutated NSCLC receiving consolidation durvalumab or osimertinib after chemoradiotherapy. Primary outcomes were PFS. Two independent reviewers screened records in Covidence. Of 160 records identified, 37 underwent full-text review and 5 met inclusion criteria.
RESULTS: Five studies (2 randomized controlled trials and 3 observational studies) contributed six unique PFS comparisons, as one randomized trial (LAURA) reported PFS by both blinded independent central review and investigator assessment. Sample sizes ranged from 35 patients (PACIFIC EGFR-mutant subgroup) to 216 patients (LAURA), with median ages in the mid-60s and predominance of exon 19 deletions and L858R mutations.
Consolidation osimertinib demonstrated substantial efficacy in the phase 3 LAURA trial, with an observed median PFS of 39.1 months by blinded independent central review (hazard ratio [HR] 0.16; 95% CI 0.10-0.24) and 38.9 months by investigator assessment (HR 0.19; 95% CI, 0.12-0.29), compared with 5.6 and 7.3 months for placebo, respectively.
Consolidation durvalumab showed variable benefit across studies, with observed median PFS ranging from 10.3 to 17.5 months. While one real-world cohort reported improved PFS versus chemoradiotherapy alone, other studies showed no statistically significant improvement over observation or placebo. Across studies, durvalumab PFS estimates remained shorter than those observed with osimertinib.
CONCLUSIONS: Consolidation osimertinib is associated with a longer observed median PFS than consolidation durvalumab in patients with unresectable, stage III, EGFR-mutated NSCLC, supporting osimertinib as preferred consolidation therapy.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO108
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Oncology, SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)