EGFR-mutated non-small-cell lung cancer: the decisions you may face
6 treatment settings, 5 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Advanced, first line (exon 19 deletion or L858R)
Osimertinib alone (FLAURA), osimertinib plus platinum-pemetrexed (FLAURA2) for patients with high burden or brain metastases who can take chemotherapy, or amivantamab plus lazertinib (MARIPOSA) with prophylaxis against rash and clots.
Osimertinib (Tagrisso) is the standard pill for EGFR-mutant lung cancer, now also given after surgery and with chemotherapy or after chemoradiation.
A two-armed antibody that blocks EGFR and its escape partner MET, now first-line for EGFR-mutant lung cancer with lazertinib.
A third-generation EGFR pill used together with amivantamab as the first regimen to beat osimertinib in EGFR-mutant lung cancer.
- Tests OsimertinibUntreated advanced non-small-cell lung cancer with an EGFR exon 19 deletion or L858R mutation: osimertinib versus gefitinib or erlotinib
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Median progression-free survival 18.9 vs 10.2 months (hazard ratio 0.46); median overall survival 38.6 vs 31.8 months (hazard ratio 0.80).
Progression-free survival (months): Osimertinib 18.9 (n=279) vs Gefitinib or erlotinib 10.2 (n=277) · HR 0.46 · source - Tests OsimertinibFirst-line EGFR-mutant NSCLC: osimertinib + chemotherapy vs osimertinib
PFS HR 0.62; OS HR 0.77.
Progression-free survival (investigator) (months): Osimertinib + chemotherapy 25.5 (n=279) vs Osimertinib 16.7 (n=278) · HR 0.62 · source - Tests AmivantamabFirst-line EGFR-mutant NSCLC: amivantamab + lazertinib vs osimertinib
PFS HR 0.70; OS HR 0.75.
Progression-free survival (BICR) (months): Amivantamab + lazertinib 23.7 (n=429) vs Osimertinib 16.6 (n=429) · HR 0.7 · source
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Decreased appetite · FLAURA | 20% | 2.5% |
| Diarrhoea · FLAURA | 58% | 2.2% |
| Fatigue · FLAURA | 21% | 1.4% |
| Rash · FLAURA | 58% | 1.1% |
- Known QT prolongation. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
- No adjustment for mild or moderate impairment; not studied in severe.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Rash · MARIPOSA, with lazertinib | 86% | 26% |
| Nail toxicity · MARIPOSA, with lazertinib | 71% | 11% |
| Venous thromboembolism · MARIPOSA, with lazertinib | 36% | 11% |
| Infusion-related reaction · MARIPOSA, with lazertinib | 63% | 6% |
- No food effect (intravenous or subcutaneous antibody).
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Between Osimertinib, Amivantamab and Lazertinib, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in FLAURA and FLAURA2, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- Which side effects of Osimertinib or Amivantamab are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Non-Small Cell Lung Cancer), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (advanced, first line (exon 19 deletion or l858r)), which of the standard options do you recommend and why?Why: Guideline options include: Osimertinib alone (FLAURA), osimertinib plus platinum-pemetrexed (FLAURA2) for patients with high burden or brain metastases who can take chemotherapy, or amivantamab plus lazertinib (MARIPOSA) with prophylaxis against rash and clots.
- Am I a candidate for Osimertinib, Amivantamab, Lazertinib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of FLAURA and FLAURA2 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Advanced, exon 20 insertion
Amivantamab plus carboplatin-pemetrexed first line (PAPILLON); sunvozertinib after platinum chemotherapy.
A two-armed antibody that blocks EGFR and its escape partner MET, now first-line for EGFR-mutant lung cancer with lazertinib.
An oral drug for EGFR exon 20 insertion lung cancer that succeeded where mobocertinib failed; approved in China (2023) and the US (2025).
Carboplatin is a platinum chemotherapy that crosslinks DNA; it is part of the standard pre-surgery regimen for triple-negative breast cancer.
Pemetrexed is the chemotherapy that, with a platinum drug, became the first approved treatment for mesothelioma in 2004, and is still the backbone today.
- A Study of Combination Amivantamab and Carboplatin-Pemetrexed Therapy, Compared With Carboplatin-Pemetrexed, in Participants With Advanced or Metastatic Non-Small Cell Lung Cancer Characterized by Epidermal Growth Factor Receptor (EGFR) Exon 20 InsertionsPhase 3NCT04538664308 peopleevidence 47A Randomized, Open-label Phase 3 Study of Combination Amivantamab and Carboplatin-Pemetrexed Therapy, Compared With Carboplatin-Pemetrexed, in Patients With EGFR Exon 20ins Mutated Locally Advanced or Metastatic Non-Small Cell Lung Cancer
No headline result recorded yet.
- Assessing an Oral EGFR Inhibitor, Sunvozertinib in Patients Who Have Advanced Non-small Cell Lung Cancer With EGFR or HER2 Mutation (WU-KONG1)Phase 1/2NCT03974022315 peopleevidence 25Tests SunvozertinibA Phase I/II, Open-Label, Multicenter Study to Assess the Safety, Tolerability, Pharmacokinetics and Anti-tumor Efficacy of DZD9008 in Patients With Advanced Non-Small Cell Lung Cancer (NSCLC) With EGFR or HER2 Mutation
No headline result recorded yet.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Rash · MARIPOSA, with lazertinib | 86% | 26% |
| Nail toxicity · MARIPOSA, with lazertinib | 71% | 11% |
| Venous thromboembolism · MARIPOSA, with lazertinib | 36% | 11% |
| Infusion-related reaction · MARIPOSA, with lazertinib | 63% | 6% |
- No food effect (intravenous or subcutaneous antibody).
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Dose by Calvert formula using GFR (see the calculators).
- Not recommended for CrCl below 45.
- Between Amivantamab, Sunvozertinib, Carboplatin and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in A Study of Combination Amivantamab and Carboplatin-Pemetrexed Therapy, Compared With Carboplatin-Pemetrexed, in Participants With Advanced or Metastatic Non-Small Cell Lung Cancer Characterized by Epidermal Growth Factor Receptor (EGFR) Exon 20 Insertions and Assessing an Oral EGFR Inhibitor, Sunvozertinib in Patients Who Have Advanced Non-small Cell Lung Cancer With EGFR or HER2 Mutation (WU-KONG1), and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- Which side effects of Amivantamab are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Non-Small Cell Lung Cancer), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (advanced, exon 20 insertion), which of the standard options do you recommend and why?Why: Guideline options include: Amivantamab plus carboplatin-pemetrexed first line (PAPILLON); sunvozertinib after platinum chemotherapy.
- Am I a candidate for Amivantamab, Sunvozertinib, Carboplatin or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of A Study of Combination Amivantamab and Carboplatin-Pemetrexed Therapy, Compared With Carboplatin-Pemetrexed, in Participants With Advanced or Metastatic Non-Small Cell Lung Cancer Characterized by Epidermal Growth Factor Receptor (EGFR) Exon 20 Insertions and Assessing an Oral EGFR Inhibitor, Sunvozertinib in Patients Who Have Advanced Non-small Cell Lung Cancer With EGFR or HER2 Mutation (WU-KONG1) apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Advanced, after osimertinib
Biopsy or plasma test for the mechanism: osimertinib plus savolitinib for MET amplification; otherwise amivantamab plus platinum chemotherapy (MARIPOSA-2), platinum-pemetrexed, or datopotamab deruxtecan after chemotherapy; platinum-etoposide for small-cell transformation.
A two-armed antibody that blocks EGFR and its escape partner MET, now first-line for EGFR-mutant lung cancer with lazertinib.
Savolitinib is a Chinese-discovered pill that blocks the MET growth signal, approved in China for lung cancers with a MET exon 14 mutation and being tested worldwide with osimertinib.
Datopotamab deruxtecan (Datroway) is the second TROP2 ADC and shares Enhertu's payload. In 2026 it became a first-line option for triple-negative breast cancer patients who cannot receive immunotherapy.
Platinum plus etoposide has been the chemotherapy backbone of small-cell lung cancer for over 40 years, and is now given with immunotherapy.
- A Study of Amivantamab and Lazertinib in Combination With Platinum-Based Chemotherapy Compared With Platinum-Based Chemotherapy in Patients With Epidermal Growth Factor Receptor (EGFR)-Mutated Locally Advanced or Metastatic Non- Small Cell Lung Cancer After Osimertinib FailurePhase 3NCT04988295776 peopleevidence 49Tests AmivantamabA Phase 3, Open-Label, Randomized Study of Amivantamab and Lazertinib in Combination With Platinum-Based Chemotherapy Compared With Platinum-Based Chemotherapy in Patients With EGFR-Mutated Locally Advanced or Metastatic Non-Small Cell Lung Cancer After Osimertinib Failure
No headline result recorded yet.
- Osimertinib Plus Savolitinib in EGFRm+/MET+ NSCLC Following Prior OsimertinibPhase 2NCT03778229367 peopleevidence 33Tests SavolitinibA Phase II Study Assessing the Efficacy of Osimertinib in Combination With Savolitinib in Patients With EGFRm+ and MET+, Locally Advanced or Metastatic Non Small Cell Lung Cancer Who Have Progressed Following Treatment With Osimertinib.
No headline result recorded yet.
- Tests Datopotamab deruxtecanActionable-genomic-alteration NSCLC after targeted therapy and platinum: datopotamab deruxtecan single arm
ORR 43.6% in EGFR-mutant disease.
Objective response rate (BICR) (%): Datopotamab deruxtecan, all 35.8 (n=137) vs EGFR-mutant subgroup 43.6 (n=78) · source
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Rash · MARIPOSA, with lazertinib | 86% | 26% |
| Nail toxicity · MARIPOSA, with lazertinib | 71% | 11% |
| Venous thromboembolism · MARIPOSA, with lazertinib | 36% | 11% |
| Infusion-related reaction · MARIPOSA, with lazertinib | 63% | 6% |
- No food effect (intravenous or subcutaneous antibody).
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Stomatitis · TROPION-Breast01, n=360 | 59% | 7% |
| Fatigue · TROPION-Breast01, n=360 | 44% | 4.2% |
| Nausea · TROPION-Breast01, n=360 | 56% | 1.4% |
| Keratitis · TROPION-Breast01, n=360 | 24% | 1.1% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Between Amivantamab, Savolitinib, Datopotamab deruxtecan and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in A Study of Amivantamab and Lazertinib in Combination With Platinum-Based Chemotherapy Compared With Platinum-Based Chemotherapy in Patients With Epidermal Growth Factor Receptor (EGFR)-Mutated Locally Advanced or Metastatic Non- Small Cell Lung Cancer After Osimertinib Failure and Osimertinib Plus Savolitinib in EGFRm+/MET+ NSCLC Following Prior Osimertinib, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- Which side effects of Amivantamab or Datopotamab deruxtecan are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Non-Small Cell Lung Cancer), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (advanced, after osimertinib), which of the standard options do you recommend and why?Why: Guideline options include: Biopsy or plasma test for the mechanism: osimertinib plus savolitinib for MET amplification; otherwise amivantamab plus platinum chemotherapy (MARIPOSA-2), platinum-pemetrexed, or datopotamab deruxtecan after chemotherapy; platinum-etoposide for small-cell transformation.
- Am I a candidate for Amivantamab, Savolitinib, Datopotamab deruxtecan or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of A Study of Amivantamab and Lazertinib in Combination With Platinum-Based Chemotherapy Compared With Platinum-Based Chemotherapy in Patients With Epidermal Growth Factor Receptor (EGFR)-Mutated Locally Advanced or Metastatic Non- Small Cell Lung Cancer After Osimertinib Failure and Osimertinib Plus Savolitinib in EGFRm+/MET+ NSCLC Following Prior Osimertinib apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Resected stage IB to IIIA
Surgery, adjuvant platinum chemotherapy where indicated, then three years of osimertinib (ADAURA).
Osimertinib (Tagrisso) is the standard pill for EGFR-mutant lung cancer, now also given after surgery and with chemotherapy or after chemoradiation.
- Tests OsimertinibAdjuvant osimertinib 3 years after resection of stage IB-IIIA EGFR-mutant NSCLC
OS HR 0.49.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Decreased appetite · FLAURA | 20% | 2.5% |
| Diarrhoea · FLAURA | 58% | 2.2% |
| Fatigue · FLAURA | 21% | 1.4% |
| Rash · FLAURA | 58% | 1.1% |
- Known QT prolongation. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
- No adjustment for mild or moderate impairment; not studied in severe.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Is Osimertinib the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?Why: A single standard does not mean a single choice; timing and trials are decisions too.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in ADAURA, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- Which side effects of Osimertinib are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Non-Small Cell Lung Cancer), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (resected stage ib to iiia), which of the standard options do you recommend and why?Why: Guideline options include: Surgery, adjuvant platinum chemotherapy where indicated, then three years of osimertinib (ADAURA).
- Am I a candidate for Osimertinib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of ADAURA apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Unresectable stage III
Concurrent platinum chemoradiation followed by osimertinib until progression (LAURA) rather than durvalumab.
Osimertinib (Tagrisso) is the standard pill for EGFR-mutant lung cancer, now also given after surgery and with chemotherapy or after chemoradiation.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
- Conformal dose, fewer side effects
- Hypofractionation saves visits
- Tests OsimertinibUnresectable stage III EGFR-mutant NSCLC after chemoradiation: osimertinib until progression vs placebo
PFS HR 0.16.
Progression-free survival (BICR) (months): Osimertinib 39.1 (n=143) vs Placebo 5.6 (n=73) · HR 0.16 · source
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Decreased appetite · FLAURA | 20% | 2.5% |
| Diarrhoea · FLAURA | 58% | 2.2% |
| Fatigue · FLAURA | 21% | 1.4% |
| Rash · FLAURA | 58% | 1.1% |
- Known QT prolongation. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
- No adjustment for mild or moderate impairment; not studied in severe.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Low-dose bath to normal tissue
- Motion management
- Between Osimertinib and IMRT / IGRT (modern external beam), which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in LAURA, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- Which side effects of Osimertinib are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Non-Small Cell Lung Cancer), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (unresectable stage iii), which of the standard options do you recommend and why?Why: Guideline options include: Concurrent platinum chemoradiation followed by osimertinib until progression (LAURA) rather than durvalumab.
- Am I a candidate for Osimertinib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of LAURA apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Brain and leptomeningeal metastases
Osimertinib has high brain penetration and is preferred; stereotactic radiosurgery for symptomatic or large lesions; high-dose osimertinib for leptomeningeal disease.
Osimertinib (Tagrisso) is the standard pill for EGFR-mutant lung cancer, now also given after surgery and with chemotherapy or after chemoradiation.
A single very high dose, or a few doses, aimed at a small brain or spine target with millimetre precision, replacing whole-brain radiotherapy for most brain metastases.
- One to five sessions
- Spares healthy brain
- Treats targets surgery cannot reach
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Decreased appetite · FLAURA | 20% | 2.5% |
| Diarrhoea · FLAURA | 58% | 2.2% |
| Fatigue · FLAURA | 21% | 1.4% |
| Rash · FLAURA | 58% | 1.1% |
- Known QT prolongation. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
- No adjustment for mild or moderate impairment; not studied in severe.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Limited to small targets
- Radiation necrosis in a minority
- Needs precise imaging and immobilisation
- Between Osimertinib and Stereotactic radiosurgery (Gamma Knife, CyberKnife, linac SRS), which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- Which side effects of Osimertinib are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Non-Small Cell Lung Cancer), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (brain and leptomeningeal metastases), which of the standard options do you recommend and why?Why: Guideline options include: Osimertinib has high brain penetration and is preferred; stereotactic radiosurgery for symptomatic or large lesions; high-dose osimertinib for leptomeningeal disease.
- Am I a candidate for Osimertinib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Add these to your appointment list, or take the full question set for this cancer.