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Prof. Dr. Mustafa Özdoğan · Medical Oncologist

The Current State of EGFR-Mutated Lung Cancer: FLAURA2, MARIPOSA, and ESMO 2026

The Current State of EGFR-Mutated Lung Cancer: FLAURA2, MARIPOSA, and ESMO 2026
In this article

22 Years of EGFR-Mutant Lung Cancer: From Chemotherapy to Combinations and ESMO 2026, Where We Stand Today

EGFR-mutant non-small cell lung cancer is one of the most successful examples of targeted therapy. Since EGFR mutations were discovered in 2004, median survival in metastatic disease has risen from about 1–2 years in the chemotherapy era to more than 4 years with today's most effective combinations. Five late-breaking abstracts in this field were presented at ESMO 2026; the MET-targeted SAFFRON trial and antibody–drug conjugates opened a new chapter in treatment after osimertinib. The historical overview presented at the congress by Dr. Natasha Leighl summed up this journey on a single slide. In this article we review the historical development, direct and indirect comparisons, and the situation in Turkey. We have covered osimertinib, amivantamab, lazertinib and WCLC 2026 in separate articles.

10–15%Frequency of EGFR mutations in lung adenocarcinomas in Europe; about half in East Asia
47.5 monthsFLAURA2: median overall survival with osimertinib + chemotherapy
HR 0.75MARIPOSA: 25% relative reduction in the risk of loss of life with amivantamab + lazertinib
5Late-breaking abstracts on EGFR-mutant lung cancer at ESMO 2026
Quick Answer · Physician Summary
  • First-line standard: Osimertinib alone, osimertinib + platinum-pemetrexed (FLAURA2) or amivantamab + lazertinib (MARIPOSA). Both combinations prolonged overall survival compared with osimertinib (HR 0.77 and 0.75), but they clearly increase side effects; they have not been compared head to head.
  • Early stage: Three years of osimertinib after surgery (ADAURA) prolongs overall survival; in unresectable stage III, osimertinib after chemoradiotherapy (LAURA) increased progression-free survival from 5.6 to 39.1 months.
  • After osimertinib: Re-biopsy and molecular testing are decisive. In MET-driven resistance, osimertinib + savolitinib (SAFFRON, ESMO 2026: overall survival HR 0.68); in unselected patients, amivantamab + chemotherapy, TROP2- or EGFR×HER3-targeted antibody–drug conjugates and ivonescimab + chemotherapy are more effective than chemotherapy.
  • Turkey: Osimertinib is reimbursed by SGK (the Turkish Social Security Institution) only for first-line treatment of metastatic disease; amivantamab and lazertinib are not licensed. Access to the combinations and to new drugs after osimertinib is limited.

Why does this matter?

EGFR (epidermal growth factor receptor) mutations are found in about 10–15% of lung adenocarcinomas in Europe and about 40–50% in East Asia. They are more common in people who have never smoked, in women and in younger patients. About 85–90% of mutations belong to two so-called "classical" types: exon 19 deletion and the exon 21 L858R point mutation. This article focuses mainly on these two classical mutations; exon 20 insertions and atypical mutations such as PACC are treated with different drugs.

In EGFR-mutant lung cancer, immunotherapy alone is usually ineffective, whereas targeted drugs produce dramatic responses. However, the disease almost always develops resistance at some point. The story of the last 20 years is the story of delaying this resistance with more effective drugs and finding the right treatment once resistance appears (differences between small cell and non-small cell lung cancer).

Historical development: from 2000 to 2026

Milestones in the EGFR story
Early 2000s
Platinum-based chemotherapy
Standard in metastatic lung cancer; median progression-free survival about 6 months, overall survival about 1–2 years.
2004
Discovery of EGFR mutations
EGFR mutations were identified in patients with dramatic responses to gefitinib (Lynch, Paez). T790M (2005), MET amplification (2007) and C797S (2015) were shown to be resistance mechanisms.
2009
IPASS
Gefitinib was superior to chemotherapy in EGFR-mutant patients; the era of biomarker-based patient selection began.
2013–2018
1st- and 2nd-generation EGFR inhibitors
Erlotinib, gefitinib, afatinib and dacomitinib were approved first line; median progression-free survival rose to 9–15 months.
2015–2018
3rd generation: osimertinib
Approved first for T790M resistance (2015), then first line in 2018 based on FLAURA; also effective against brain metastases.
2020
Early stage and combinations
Osimertinib after surgery was approved based on ADAURA, and erlotinib + ramucirumab based on RELAY.
2024
The era of combinations
FLAURA2 (osimertinib + chemotherapy), MARIPOSA (amivantamab + lazertinib), MARIPOSA-2 (amivantamab + chemotherapy after osimertinib) and LAURA (osimertinib after chemoradiotherapy in stage III) led to approvals.
2025
Overall survival and antibody–drug conjugates
An overall survival benefit was shown in FLAURA2 and MARIPOSA; datopotamab deruxtecan in the US and sacituzumab tirumotecan in China were approved after osimertinib; subcutaneous amivantamab was approved.
October 2026
ESMO 2026
SAFFRON (MET-targeted), SANOVO (MET, first line), OptiTROP-Lung04 (final survival), PANKU-Lung01 (EGFR×HER3-targeted conjugate) and HERON-Lung01 were presented.

What is the standard treatment for EGFR-mutant lung cancer today?

In metastatic lung cancer with a classical EGFR mutation (exon 19 deletion or L858R), first-line options are osimertinib alone, osimertinib + platinum-pemetrexed, or amivantamab + lazertinib. Patients who undergo surgery receive 3 years of osimertinib afterwards, and those with unresectable stage III receive osimertinib after chemoradiotherapy. When the disease progresses on osimertinib, treatment is chosen according to the resistance mechanism identified by re-biopsy.

Figure 1 · Treatment pathway by stage (October 2026)

Non-small cell lung cancer with a classical EGFR mutation

Early and locally advanced stage Resectablestage IB–IIIAsurgery ± chemotherapythen 3 years osimertinib Unresectablestage IIIchemoradiotherapythen osimertinib Metastatic disease · first line Three standard optionsosimertinib aloneosimertinib + platinum-pemetrexed (FLAURA2)amivantamab + lazertinib (MARIPOSA) Progression: re-biopsy and molecular testingtissue and/or blood (liquid biopsy), IHC/FISH for MET MET-driven resistanceosimertinib +savolitinib(SAFFRON) No clear targetamivantamab +chemotherapy, ADCor chemotherapy Small cell lung cancertransformation:suitable chemotherapy C797S, HER2, ALK…matching targeted drugor clinical trial
How to read it: The two boxes at the top show early and locally advanced stage, the middle boxes show first-line options in metastatic disease, and the bottom boxes show options after progression on osimertinib according to the resistance mechanism. The diagram is a general roadmap; for each patient, the choice depends on the features of the disease, the risk of side effects and access to treatment.

First-line treatment of metastatic disease: direct comparisons

A "direct comparison" means that two treatments are compared at random (randomized) within the same phase 3 trial. In the EGFR field, each new treatment was compared directly with the standard of its time: first chemotherapy, then 1st-generation drugs and most recently osimertinib. As a result, the control arm of each trial represents the best treatment of the previous era.

Trial (year) Experimental arm Control arm Median progression-free survival (months) Overall survival
IPASS (2009) Gefitinib Carboplatin-paclitaxel 9.5 / 6.3 (HR 0.48)* No difference (crossover)
EURTAC (2012) Erlotinib Platinum-based chemotherapy 9.7 / 5.2 No difference (crossover)
ARCHER 1050 (2017) Dacomitinib Gefitinib 14.7 / 9.2 34.1 / 26.8 months
RELAY (2019) Erlotinib + ramucirumab Erlotinib 19.4 / 12.4 No difference shown
FLAURA (2018–2020) Osimertinib Gefitinib or erlotinib 18.9 / 10.2 (HR 0.46) 38.6 / 31.8 months (HR 0.80)
FLAURA2 (2023–2025) Osimertinib + platinum-pemetrexed Osimertinib 25.5 / 16.7 (HR 0.62) 47.5 / 37.6 months (HR 0.77)
MARIPOSA (2024–2025) Amivantamab + lazertinib Osimertinib 23.7 / 16.6 (HR 0.70) Not reached / 36.7 months (HR 0.75)

* EGFR-mutant subgroup in IPASS. An HR (hazard ratio) below 1 favors the experimental arm; for example, an HR of 0.75 means a relative reduction of about 25% in the risk of loss of life during follow-up. The 3rd-generation drugs developed in Asia, aumolertinib (AENEAS: 19.3 / 9.9 months), furmonertinib (FURLONG: 20.8 / 11.1 months) and lazertinib (LASER301: 20.6 / 9.7 months), were also superior to 1st-generation drugs.

Progression-free survival in first line over 17 years

Median progression-free survival (months). In each trial, the experimental arm is in color and its own control arm in gray.

IPASS: chemotherapy
6.3 mo
IPASS: gefitinib
9.5 mo
ARCHER 1050: gefitinib
9.2 mo
ARCHER 1050: dacomitinib
14.7 mo
FLAURA: gefitinib/erlotinib
10.2 mo
FLAURA: osimertinib
18.9 mo
FLAURA2: osimertinib
16.7 mo
FLAURA2: osimertinib + chemotherapy
25.5 mo
MARIPOSA: osimertinib
16.6 mo
MARIPOSA: amivantamab + lazertinib
23.7 mo

The IPASS value is from the EGFR-mutant subgroup. Comparisons across different studies are indirect; patient populations, prior treatments and follow-up differ.

Overall survival data show that a gain in progression-free survival does not always translate into longer life. IPASS and EURTAC showed no overall survival difference, because most patients in the chemotherapy arm switched to an EGFR inhibitor when their disease progressed. In FLAURA, osimertinib became the first EGFR inhibitor to also prolong overall survival. FLAURA2 and MARIPOSA then showed that adding a further treatment to osimertinib can extend survival.

Overall survival in first line

Median overall survival (months). Experimental arm in color, control arm in gray.

ARCHER 1050: gefitinib
26.8 mo
ARCHER 1050: dacomitinib
34.1 mo
FLAURA: gefitinib/erlotinib
31.8 mo
FLAURA: osimertinib
38.6 mo
FLAURA2: osimertinib
37.6 mo
FLAURA2: osimertinib + chemotherapy
47.5 mo

In MARIPOSA, the median has not yet been reached in the amivantamab + lazertinib arm (36.7 months in the osimertinib arm; HR 0.75), so it is not shown in the chart. Comparisons across different studies are indirect; patient populations, prior treatments and follow-up differ.

How large is the absolute difference?

In FLAURA2, median overall survival was about 10 months longer (47.5 vs 37.6 months). In MARIPOSA, the median has not yet been reached in the amivantamab + lazertinib arm; the 3-year overall survival rate was about 60% vs 51%. In other words, after 3 years, about 9 more patients out of every 100 are alive. On the other hand, both combinations clearly increase serious side effects and add to the treatment burden.

FLAURA2 or MARIPOSA? An indirect comparison

Osimertinib + chemotherapy and amivantamab + lazertinib have never been compared directly in a trial. Because both trials used osimertinib as the control arm, the results can be placed side by side, but this "indirect comparison" does not provide a definitive ranking. Patient populations, rates of brain metastases, follow-up times and treatments received after osimertinib all differ.

Feature Osimertinib + chemotherapy (FLAURA2) Amivantamab + lazertinib (MARIPOSA)
Median progression-free survival (vs osimertinib) 25.5 / 16.7 months (HR 0.62) 23.7 / 16.6 months (HR 0.70)
Overall survival (vs osimertinib) 47.5 / 37.6 months (HR 0.77) Not reached / 36.7 months (HR 0.75)
Grade 3 or higher side effects About 64% / 27% About 80% / 52%
Prominent side effects Low blood counts (anemia, neutropenia), fatigue, nausea Skin rash, inflammation around the nails, edema, infusion reactions, blood clots
Blood clots (venous thromboembolism) No marked increase reported Marked increase; anticoagulant medication recommended for the first 4 months
Administration Intravenous every 3 weeks (4 cycles of platinum, then pemetrexed maintenance) + daily tablet Intravenous or subcutaneous amivantamab + daily tablet
Groups in which the benefit appears greater Brain metastases, L858R mutation Brain metastases, L858R, TP53 co-mutation, EGFR detected in blood (ctDNA)

The side-effect cost of combinations

Proportion of patients with grade 3 or higher side effects (%). In each trial, the combination is in color and the osimertinib arm in gray.

FLAURA2: osimertinib
27%
FLAURA2: osimertinib + chemotherapy
64%
MARIPOSA: osimertinib
52%
MARIPOSA: amivantamab + lazertinib
80%

Side-effect definitions and follow-up times differ between trials; this may also explain why the rates in the osimertinib arms of the two trials differ. Comparisons across different studies are indirect; patient populations, prior treatments and follow-up differ.

Which treatment for which patient?

There is no definitive answer; the decision is made together with the patient. Combinations come to the fore in patients with high-risk disease features (brain metastases, L858R, TP53 co-mutation, extensive disease) who can tolerate intensive treatment. In older patients, those with other illnesses or those who want to avoid side effects, osimertinib alone remains a strong option. Access to the drug is also decisive; in Turkey, amivantamab and lazertinib are not licensed.

What has changed in early-stage disease?

Treatment of EGFR-mutant lung cancer is no longer limited to metastatic disease. For this reason, EGFR testing is recommended for every patient with non-small cell lung cancer who undergoes surgery (lung cancer stages and treatment).

  • ADAURA (after surgery): In patients with stage IB–IIIA disease, 3 years of osimertinib after surgery (± chemotherapy) reduced the risk of recurrence by about 80% (disease-free survival HR 0.20). Five-year overall survival was 88% vs 78% (HR 0.49). In 8-year data presented at WCLC 2026, overall survival in stage II–IIIA was 74% vs 58% (HR 0.53).
  • LAURA (unresectable stage III): Osimertinib after chemoradiotherapy increased median progression-free survival from 5.6 to 39.1 months (HR 0.16). FDA approval came in September 2024. Overall survival data are not yet mature.
  • NeoADAURA (before surgery): Osimertinib before surgery (with chemotherapy or alone) increased the major pathological response rate from 2% to 26% and 25%. Long-term survival data are awaited.
HR 0.20ADAURA: about 80% relative reduction in the risk of recurrence with osimertinib after surgery
88%ADAURA: 5-year overall survival with osimertinib (78% with placebo)
39.1 monthsLAURA: median progression-free survival with osimertinib (5.6 months with placebo)
26%NeoADAURA: major pathological response with osimertinib + chemotherapy (2% with chemotherapy)
Open questions in early-stage disease

In ADAURA, osimertinib was given for 3 years; after treatment ends, some of the recurrences that had been held back reappear. Researchers are investigating whether longer treatment is beneficial and whether treatment can be personalized by monitoring tumor DNA in the blood (ctDNA) after surgery (postoperative ctDNA testing).

After osimertinib: how does resistance develop?

In almost all patients receiving osimertinib, the disease progresses at some point. Resistance mechanisms fall broadly into two groups: a new change in the EGFR gene itself, or a switch by the tumor to another growth pathway that is independent of EGFR (how cancer cells develop resistance to treatment).

Resistance mechanism Approximate frequency (after first-line osimertinib) Treatment approach
MET amplification or overexpression 15–25% Osimertinib + MET inhibitor (savolitinib; SAFFRON)
EGFR C797S mutation Around 7% Clinical trial; 4th-generation EGFR inhibitors are in development
HER2 amplification, BRAF, ALK/RET fusions A few percent each Matching targeted drug, mostly within a trial
Transformation to small cell lung cancer or squamous histology 5–15% Chemotherapy suited to the transformed histology
No detectable mechanism About half Amivantamab + chemotherapy, antibody–drug conjugates, chemotherapy ± other agents

Frequencies vary between studies and are approximate.

Why re-biopsy?

At the time of progression, next-generation sequencing (NGS) on a tissue biopsy and/or a liquid biopsy from blood is the most important step in deciding treatment. Small cell transformation can only be identified by tissue biopsy, while MET overexpression is measured in tissue by immunohistochemistry (IHC).

Treatment options after osimertinib

For many years, the standard treatment after osimertinib was platinum-pemetrexed chemotherapy. Today there are four different approaches in this setting that outperform chemotherapy. In all the trials below, the control arm is platinum-based chemotherapy.

Trial Treatment Patient group Progression-free survival (months) Overall survival (months)
MARIPOSA-2 Amivantamab + chemotherapy Unselected 6.3 / 4.2 (HR 0.48) 17.7 / 15.3 (did not reach the significance threshold; 2nd interim analysis)
HARMONi Ivonescimab + chemotherapy Unselected 6.8 / 4.4 (HR 0.52) 16.8 / 14.0 (HR 0.79; p=0.057)
OptiTROP-Lung04 (ESMO 2026) Sacituzumab tirumotecan (TROP2 ADC) Unselected (China) 8.3 / 4.3 (HR 0.49) 25.9 / 17.4 (HR 0.69)
PANKU-Lung01 (ESMO 2026) Izalontamab brengitecan (EGFR×HER3 ADC) Unselected (China) 11.1 / 5.7 (HR 0.40) Not yet mature
SAFFRON (ESMO 2026) Osimertinib + savolitinib MET overexpression/amplification 7.6 / 5.4 (HR 0.55) 17.8 / 12.9 (HR 0.68)

ADC: antibody–drug conjugate. Datopotamab deruxtecan (TROPION-Lung05; response rate about 45%) received accelerated approval in the US in June 2025. The HER3-targeted patritumab deruxtecan, by contrast, showed no overall survival benefit in HERTHENA-Lung02.

After osimertinib: progression-free survival

Median progression-free survival (months). Experimental arm in color, platinum-based chemotherapy arm in gray.

MARIPOSA-2: chemotherapy
4.2 mo
MARIPOSA-2: amivantamab + chemotherapy
6.3 mo
HARMONi: chemotherapy
4.4 mo
HARMONi: ivonescimab + chemotherapy
6.8 mo
SAFFRON: chemotherapy
5.4 mo
SAFFRON: osimertinib + savolitinib
7.6 mo
OptiTROP-Lung04: chemotherapy
4.3 mo
OptiTROP-Lung04: sacituzumab tirumotecan
8.3 mo
PANKU-Lung01: chemotherapy
5.7 mo
PANKU-Lung01: izalontamab brengitecan
11.1 mo

SAFFRON enrolled only patients with MET overexpression/amplification; OptiTROP-Lung04 and PANKU-Lung01 were conducted in China. Comparisons across different studies are indirect; patient populations, prior treatments and follow-up differ.

After osimertinib: overall survival

Median overall survival (months). Experimental arm in color, platinum-based chemotherapy arm in gray.

MARIPOSA-2: chemotherapy
15.3 mo
MARIPOSA-2: amivantamab + chemotherapy
17.7 mo
HARMONi: chemotherapy
14 mo
HARMONi: ivonescimab + chemotherapy
16.8 mo
SAFFRON: chemotherapy
12.9 mo
SAFFRON: osimertinib + savolitinib
17.8 mo
OptiTROP-Lung04: chemotherapy
17.4 mo
OptiTROP-Lung04: sacituzumab tirumotecan
25.9 mo

In MARIPOSA-2 (second interim analysis) and HARMONi (HR 0.79; p=0.057), the difference did not reach the threshold for statistical significance; it was significant in SAFFRON (HR 0.68) and OptiTROP-Lung04 (HR 0.69). Overall survival data for PANKU-Lung01 are not yet mature. Comparisons across different studies are indirect; patient populations, prior treatments and follow-up differ.

What was presented at ESMO 2026?
  • SAFFRON (LBA6): 338 patients whose disease progressed after osimertinib and whose tumors had high-level MET overexpression (IHC 3+ in 90% or more of cells) and/or MET amplification (10 or more copies by FISH). Compared with chemotherapy, osimertinib + savolitinib prolonged progression-free survival (7.6 vs 5.4 months; HR 0.55) and overall survival (17.8 vs 12.9 months; HR 0.68); the response rate was 51% vs 27%. Grade 3 or higher treatment-related side effects occurred in 40% vs 52%. Being an all-tablet combination, it offers a way to avoid chemotherapy. The results were published simultaneously in NEJM; the FDA application was submitted in September 2026.
  • SANOVO (LBA69): First-line osimertinib + savolitinib versus osimertinib + placebo in 326 patients with MET overexpression in China. A significant improvement in the primary endpoint, progression-free survival, was announced; detailed figures are not available in the sources this article is based on.
  • OptiTROP-Lung04 (LBA67): In the final analysis, the TROP2-targeted sacituzumab tirumotecan increased overall survival from 17.4 to 25.9 months (HR 0.69); 2-year overall survival was 54% vs 37%. Lung inflammation (ILD) occurred at a low rate of 0.5%.
  • PANKU-Lung01 (LBA71): Izalontamab brengitecan, a bispecific antibody–drug conjugate that targets EGFR and HER3 simultaneously, doubled progression-free survival (11.1 vs 5.7 months; HR 0.40); the response rate was 60% vs 35%. The results were published simultaneously in The Lancet.
  • HERON-Lung01 (LBA72): Another HER3-targeted antibody–drug conjugate; numerical results were not available at the time of writing.

The results of trials conducted in China need to be confirmed in Western patient populations. In HARMONi, a similar trend (HR 0.76) was seen in the Western subgroup; an FDA decision on ivonescimab is expected on 14 November 2026. For lung side effects of antibody–drug conjugates, see our article on T-DXd and lung inflammation.

What is on the horizon?

  • 4th-generation EGFR inhibitors: Drugs targeting osimertinib resistance mutations such as C797S (for example silevertinib, DZD6008) have shown responses in early-phase trials; at ASCO 2026, a response rate of 41.7% was reported with DZD6008 in C797X mutations.
  • Subcutaneous amivantamab: Received FDA approval in December 2025; it markedly reduces infusion reactions and administration time. A once-monthly dosing schedule was approved in February 2026.
  • Moving combinations into first line: Antibody–drug conjugates and MET inhibitors are being tested together with osimertinib in the first-line setting.
  • Atypical mutations: In CHRYSALIS-2, a median overall survival of 41 months was reported with amivantamab + lazertinib in atypical EGFR mutations.
  • Blood-based monitoring: Clearance of ctDNA during treatment may help identify who needs intensive treatment.

Involvement of the brain and its lining (meninges) is common in these patients; we covered this topic in our article on leptomeningeal metastasis. Clinical trials are another route to new drugs.

How should the results be interpreted?

  • Progression-free survival does not always mean overall survival: In treatment after osimertinib, many trials delayed progression, but the effect on survival has been more limited or is still uncertain. At present, an overall survival benefit is most clearly seen in SAFFRON and OptiTROP-Lung04.
  • The control arm matters: In FLAURA2 and MARIPOSA the control arm was osimertinib; in trials after osimertinib it was chemotherapy. When results from different trials are placed side by side, the comparison is indirect.
  • Where the trials were conducted: OptiTROP-Lung04, PANKU-Lung01 and SANOVO were conducted only in China; the same effect still needs to be shown in Western patients.
  • The cost in side effects: The survival gain from intensive treatment should be weighed against side effects and treatment burden; in advanced disease, quality of life is at least as important as length of life.
The situation in Turkey

Osimertinib (Tagrisso) is licensed in Turkey; however, since 20 November 2024, SGK reimbursement has covered only first-line use in metastatic disease. Use after surgery (ADAURA), after chemoradiotherapy (LAURA) and in combination with chemotherapy (FLAURA2) is not reimbursed. Amivantamab (including the subcutaneous form) and lazertinib are not licensed in Turkey and are not covered by SGK; these drugs can be accessed only to a limited extent through an off-label use permit and import of medicines from abroad. Savolitinib, sacituzumab tirumotecan, izalontamab brengitecan and ivonescimab are not licensed in Turkey. 1st- and 2nd-generation EGFR inhibitors (erlotinib, gefitinib, afatinib) can be used first line. For details, see our article FDA-approved new cancer drugs: access map for Turkey.

Advice for patients and their families

  • Ask for molecular testing: Every patient diagnosed with lung adenocarcinoma, regardless of stage, should have comprehensive molecular testing that includes EGFR. Immunotherapy should not be started before the test result is available (careful planning of immunotherapy).
  • Find out the mutation type: Whether it is an exon 19 deletion, L858R or an atypical mutation affects the choice of treatment. Other changes, such as exon 20 insertions and HER2 mutations, are treated with different drugs.
  • Discuss the options together: Osimertinib alone or a combination? The expected benefit, side effects, frequency of treatment and access to the drug should be discussed. If needed, a second opinion can make the decision easier.
  • Re-biopsy at progression: When the disease progresses, repeat tissue and/or blood testing can reveal findings that change treatment, such as MET-driven resistance or small cell transformation.
  • Report side effects early: Skin rash, inflammation around the nails, leg swelling, shortness of breath and cough can usually be controlled when noticed early. If you are receiving amivantamab, talk to your doctor about anticoagulant treatment.
  • Stay active: Regular exercise during treatment reduces fatigue and supports quality of life (rehabilitation and exercise in lung cancer).

It is worth remembering that lung cancer can also occur in people who do not smoke and in women, and that EGFR mutations are more common in this group (facts about lung cancer). For people who smoke, screening with low-dose CT is recommended. For a summary of recent approvals, see our articles on FDA approvals that changed lung cancer treatment in 2025 and, for pre-congress expectations, our ESMO 2026 preview.

Frequently asked questions

What is the first-choice treatment for EGFR-mutant lung cancer?
For classical EGFR mutations (exon 19 deletion or L858R), there are three standard options: osimertinib alone, osimertinib + platinum-pemetrexed chemotherapy (FLAURA2) and amivantamab + lazertinib (MARIPOSA). Both combinations extended survival compared with osimertinib (HR 0.77 and 0.75), but serious side effects are more frequent. The choice depends on the features of the disease, the patient's general condition and access to the drugs.
Is FLAURA2 or MARIPOSA better?
The two treatments have never been compared directly in a trial. Both prolonged progression-free and overall survival to a similar extent compared with osimertinib. With osimertinib + chemotherapy, low blood counts are the main concern; with amivantamab + lazertinib, skin side effects, infusion reactions and the risk of blood clots stand out. In Turkey, amivantamab and lazertinib are not licensed.
What happens when osimertinib stops working?
First, the resistance mechanism is investigated with a re-biopsy or a molecular blood test. If there is MET-driven resistance, osimertinib + savolitinib (SAFFRON) extended survival compared with chemotherapy. If there is no clear target, options include amivantamab + chemotherapy, antibody–drug conjugates or platinum-based chemotherapy. In small cell transformation, appropriate chemotherapy is given.
What was presented on EGFR-mutant lung cancer at ESMO 2026?
Five late-breaking abstracts were presented. In SAFFRON, osimertinib + savolitinib extended survival in patients with MET-driven resistance (17.8 vs 12.9 months). In OptiTROP-Lung04, sacituzumab tirumotecan increased overall survival to 25.9 months. In PANKU-Lung01, izalontamab brengitecan extended progression-free survival to 11.1 months. SANOVO showed the benefit of a MET-targeted combination in the first-line setting; HERON-Lung01 was also presented.

Glossary

EGFR
Epidermal growth factor receptor; a protein that regulates cell growth. When it is mutated, the tumor becomes dependent on this pathway for its growth.
EGFR tyrosine kinase inhibitor (TKI)
Oral drugs that block EGFR signaling; gefitinib, erlotinib, afatinib, dacomitinib, osimertinib and lazertinib belong to this group.
Bispecific antibody
An antibody that binds to two different targets at the same time; amivantamab binds to both EGFR and MET.
Antibody–drug conjugate (ADC)
A drug consisting of an antibody that binds to a target on the tumor cell and a potent chemotherapy molecule attached to it.
MET amplification
The presence of many copies of the MET gene; one of the most common causes of osimertinib resistance.
Progression-free survival
The time from the start of treatment until the disease progresses.
Overall survival
The time patients remain alive from the start of treatment.
ctDNA
Circulating tumor DNA in the blood; measured by liquid biopsy.

DROZDOGAN Academy Commentary

EGFR-mutant lung cancer is a model example of step-by-step progress through successive phase 3 trials in biomarker-selected patients. Since 2009, each new standard has arrived through a direct comparison with the previous one.

⚡ Why it matters

Adding further treatment to osimertinib in the first-line setting has, for the first time, also prolonged overall survival. After osimertinib, the "chemotherapy for everyone" approach is giving way to treatments chosen according to the resistance mechanism.

✅ Strengths

FLAURA2, MARIPOSA and SAFFRON are large, randomized phase 3 trials with mature overall survival data. In biomarker-selected patients, SAFFRON offers a way to avoid chemotherapy with an all-tablet combination.

⚠️ Limitations

There is no direct comparison between the combinations. A substantial share of the antibody–drug conjugate trials were conducted only in China. The treatments that patients in the osimertinib arm received after progression differ from country to country.

🩺 In practice

Combinations should be discussed for patients with high-risk features who can tolerate the treatment; for others, osimertinib alone is reasonable. Re-biopsy and MET assessment at progression should now be routine. In Turkey, access is one of the most important factors determining the choice of treatment.

❓ Open questions

Which combination for which patient? What should the treatment sequence be? Should antibody–drug conjugates move into first line? Can treatment intensity be personalized with ctDNA?

Bottom line: As of 2026, there is no single "best" treatment for EGFR-mutant lung cancer; the right treatment is chosen according to the patient, the biology of the disease and access. ESMO 2026 strengthened the personalization of treatment after osimertinib based on molecular testing.

Transparency note
  • This article was prepared in October 2026.
  • Data were compiled from published phase 3 trials, news reports and company statements on ESMO 2026 presentations, and FDA decisions. The full texts of the ESMO 2026 presentations were not accessed; numerical results for SANOVO and HERON-Lung01 are not included in this article.
  • Some charts show results from different trials together; in these charts the comparison is indirect. In each trial, the experimental arm is shown in color and the control arm in gray. Frequencies of resistance mechanisms are approximate.
  • Licensing and reimbursement information for Turkey reflects the date of writing and may change.
  • This article is for general information only and is not personal medical advice. The diagrams are derived from the text and contain no new data. The Academy commentary is our own.

References

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  20. PANKU-Lung01: izalontamab brengitecan phase 3. morningglorysciences.com
  21. ESMO Congress 2026. esmo.org
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The Current State of EGFR-Mutated Lung Cancer: FLAURA2, MARIPOSA, and ESMO 2026

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