Second line EGFR mutated lung ca stage 4

 ASCO recommends: Amivantamab+ carbo +pemetrexed

MARIPOSA 2 trial

PFS was significantly longer for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy [hazard ratio (HR) for disease progression or death 0.48 and 0.44, respectively; P < 0.001 for both; median of 6.3 and 8.3 versus 4.2 months, respectively.

Objective response rate was significantly higher for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy (64% and 63% versus 36%, respectively.

PFS 8 months amivantamab+ chemo with or without lazertinib.

Median intracranial PFS was 12.5 and 12.8 versus 8.3 months for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy (HR for intracranial disease progression or death 0.55 and 0.58, respectively). Predominant adverse events (AEs) in the amivantamab-containing regimens were hematologic, EGFR-, and MET-related toxicities. Amivantamab-chemotherapy had lower rates of hematologic AEs than amivantamab-lazertinib-chemotherapy.

CHRYSALIS -2 second line without chemo- ami+ laz

Amivantamab and lazertinib has demonstrated promising efficacy as a second-line treatment for patients with EGFR-mutant non-small cell lung cancer (NSCLC) who have progressed on osimertinib. The CHRYSALIS-2 study reported an overall response rate (ORR) of 36% (95% CI, 23-51) in the target population, with a clinical benefit rate (CBR) of 58% (95% CI, 43-72) and a median duration of response (mDOR) that was not reached at the time of reporting. This study also highlighted the manageable safety profile of the combination, with the most common adverse events being infusion-related reactions, paronychia, rash, and stomatitis.

The response rate of amivantamab+ lazertinib is similar to chemo alone in the second line setting ie 36%.