Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Treatment regimen

Osimertinib with pemetrexed and platinum (FLAURA2)

First line in EGFR-mutant lung cancer (exon 19 deletion or L858R)

Updated: 28 October 20261 min read3 references

Summary for doctors

  • Advanced lung cancer with exon 19 deletion or L858R, first line [1].
  • Adding chemotherapy to osimertinib lengthened progression-free survival, with more side effects [1].
  • Osimertinib alone remains a standard option; the combination is more relevant for high-volume disease or brain metastases.

Dose and schedule

Osimertinib + chemotherapy

Advanced EGFR-positive lung cancer, first lineEach drug’s schedule in the table

Advanced EGFR-positive lung cancer, first line

DrugDoseRouteSchedule
Phase 1: 4 cycles
Osimertinib80 mgOralDaily
Pemetrexed500 mg/m²IVDay 1
Cisplatin 75 mg/m² or carboplatin (Calvert-based dose)IVDay 1
Phase 2
Osimertinib80 mgOralDaily
Pemetrexed500 mg/m²IVEvery 3 weeks
Cycle schedule
Chemotherapy every 21 days; osimertinib daily
Duration
Until progression

As in FLAURA2 [1]; dose source: [2].

Evidence: FLAURA2 (2023)

Adjuvant osimertinib

EGFR-positive lung cancer after surgery (stage IB to IIIA)Cycle length: Daily

EGFR-positive lung cancer after surgery (stage IB to IIIA)

DrugDoseRouteSchedule
Osimertinib80 mg once a dayOralDaily
Cycle length
Daily
Duration
Up to 3 years

As in ADAURA [3]; dose source: [2].

Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.

Premedication and supportive care

  • Pemetrexed: folic acid, vitamin B12 and dexamethasone as in the label; antiemetics based on the platinum.

Monitoring and dose adjustment

  • Pneumonitis (ILD): investigate a new cough or dyspnoea; QTc and ejection fraction in high-risk patients; blood counts and creatinine before each cycle.

Main evidence

Show detailsHide

FLAURA2: median progression-free survival 25.5 months with the combination vs 16.7 months with osimertinib alone; grade 3 or higher adverse events were more common [1]. ADAURA: adjuvant osimertinib greatly reduced recurrence [3].

Related cancer types

Lung cancer

Treatment regimens (physicians)

Trastuzumab deruxtecan (T-DXd, Enhertu): dose and monitoringCarboplatin, pemetrexed and pembrolizumab (KEYNOTE-189)Carboplatin, paclitaxel and pembrolizumab (KEYNOTE-407)Carboplatin-etoposide with atezolizumab or durvalumab in small cell lung cancerDurvalumab after chemoradiotherapy in stage 3 lung cancer (PACIFIC)Pembrolizumab alone in lung cancer with high PD-L1 (KEYNOTE-024)Amivantamab with lazertinib (MARIPOSA)Adjuvant alectinib after surgery for ALK-positive lung cancer (ALINA)

Physician tools and lessons

Khorana Score (Cancer-Associated Thrombosis Risk)Should I Be Screened for Lung Cancer? (Pack-Year Calculator)10 cheap steps that save patients' livesManagement of brain metastasesMalignant pleural effusion: drainage, pleurodesis or an indwelling catheter

References

3 references
Show all references, 1 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    Osimertinib with or without Chemotherapy in EGFR-Mutated Advanced NSCLCPlanchard D, Jänne PA, Cheng Y, et al · N Engl J Med · 2023;389:1935-1948
    Study cardDOIPubMed Back to text: 1 2 3 4
  2. 2
    TAGRISSO (OSIMERTINIB) — Prescribing InformationAstrazeneca Pharmaceuticals LP · FDA label · 2026
    Source Back to text: 1 2
  3. 3
    Osimertinib in Resected EGFR-Mutated Non-Small-Cell Lung CancerWu YL, Tsuboi M, He J, et al · N Engl J Med · 2020;383:1711-1723
    DOIPubMed Back to text: 1 2

This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/osimertinib-chemotherapy-flaura2/

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