Osimertinib improves cancer–related symptoms in patients with advanced lung cancer, according to an analysis of patient–reported outcomes from the AURA3 phase III clinical trial presented at the European Lung Cancer Conference (ELCC).

“With my past experience conducting clinical trials, I often see new treatments that might be more effective, but are also usually more toxic,” said lead author Dr Chee Lee, Medical Oncologist, St George Hospital Cancer Care Centre, New South Wales, Australia. “Osimertinib not only increases progression–free survival but it is well–tolerated, which makes a big difference for our patients.”

AURA3 included 419 patients with advanced epidermal growth factor receptor (EGFR) mutation non–small–cell lung cancer (NSCLC) who had progressed after first–line EGFR–tyrosine kinase inhibitor (TKI) therapy. They were randomised to receive the oral TKI osimertinib or chemotherapy. Patients taking osimertinib had significantly longer progression–free survival of 10.1 months versus those on chemotherapy with 4.4 months (hazard ratio 0.30; 95% confidence interval 0.23, 0.41; p<0.001).

Researchers will present the findings on patient–reported outcomes from the AURA3 trial. Information was collected using two standardised European Organisation for Research and Treatment of Cancer (EORTC) questionnaires, the QLQ–LC13 that assessed lung cancer specific symptoms and the QLQ–C30 that assessed general cancer symptoms. Patients completed both questionnaires at baseline and then at regular intervals until disease progression and beyond. The researchers then analysed the findings to see if control of symptoms was better with osimertinib or chemotherapy.

The researchers found that osimertinib significantly reduced many lung cancer symptoms, primarily appetite loss, fatigue, breathlessness and chest pain. There was a trend for osimertinib to reduce cough but it was not statistically significant. Dr Lee said: “It generally took longer for these symptoms to get worse in patients taking the osimertinib tablet compared to chemotherapy.”

In patients who had symptoms at the start of the study, appetite loss improved significantly faster on osimertinib compared to chemotherapy, and patients became less fatigued and less breathless.

Compared to chemotherapy, osimertinib significantly improved global health status, physical functioning, role functioning and social functioning scores. There was a trend towards improved emotional and cognitive function with osimertinib but it was not statistically significant. “Patients taking osimertinib were more able to do normal daily activities and socialise than those on chemotherapy,” said Dr Lee.

He continued: “Patients with metastatic lung cancer receiving first–line treatment are really quite sick. Patients in the AURA3 trial had progressed on first–line treatment and were receiving second–line therapy, so they were even sicker. To be able to reduce cancer symptoms and improve quality of life in addition to progression–free survival for these patients is a major leap.”

Dr Lee concluded: “For patients with incurable cancer, prolonging only progression–free survival probably has very little meaning for them. However, treatment that can additionally improve symptoms and maintain quality of life probably means a lot for these patients.”