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Medicine Matters oncology

Take-home message of my presentation at ESMO 2020. The ADAURA has demonstrated that the adjuvant osimertinib produced a highly significant and clinically meaningful improvement in disease-free survival and reduced risk of the local and distant recurrence, especially improving the CNS disease-free survival in the patient who is a completely resected stage 1b, 2, and 3a EGFR mutation-positive non-small cell lung cancer.

There seems to be a wave of precision medicine in the postoperative care, although there is a limitation that the maturity of both DFS and OS are low, given the reality that the patient with the early-stage lung cancer missed the chance to cured once recurrence occurred. I believe that prolonged DFS with adjuvant osimertinib-- very useful information for the patient hoping for a cure.

In clinical practice, I think a final decision on whether or not to use adjuvant osimertinib should be made after considering the risk-benefit reccurrence including the toxicity of the cost in each patient, because some patients may be cured by surgery alone. Future consideration for the ADAURA include a subsequent treatment, longitudinal assessment of the minimal residual disease, and acquired resistance mechanism of the results.

In my opinion, patient selection is a very important issue, considering that there are patients who are cured with the surgery alone and that the adjuvant therapy is not entirely free of toxicity. I should explore the direction of delivering adjuvant therapy to those who are more at risk of recurrence using advancing in science. I'm particularly interested in the ctDNA intervention study.

And also, we have two sister studies of ADAURA. The neo ADAURA and ADAURA trials were investigating basically, efficacy and safety of the neo ADAURA osimertinib in EGFR mutant un resectable non-small cell lung cancer and osimertinib following the chemoradiotherapy in stages 3 unresectable EGFR mutation positive non-small cell lung cancer.

Thank you for your attention.