Anthony Elgamal: Redefining First-Line Treatment in EGFR-Mutated Lung Cancer

25 October, 2025 | Saturday

Anthony Elgamal: Redefining First-Line Treatment in EGFR-Mutated Lung Cancer

13 October 2025 | Monday | Expert Insight

In conversation with BioPharma APAC, Johnson & Johnson’s Vice President of Oncology for Asia Pacific discusses how the MARIPOSA trial is redefining first-line therapy with amivantamab plus lazertinib—delivering unprecedented survival gains and expanding access for patients across the region.

BioPharma APAC speaks with Anthony Elgamal, Vice President of Oncology, Johnson & Johnson Innovative Medicine Asia Pacific, on the MARIPOSA trial results and how this breakthrough combination therapy is transforming outcomes and access for patients with EGFR-mutated NSCLC.

How do the survival gains in the Asia cohort compare with global MARIPOSA data, and what might explain the magnitude of benefit seen in this region?

The MARIPOSA global trial population consists of 58% of patients of Asian origin, and their survival outcomes are consistent with the global population.

Asia has the largest population of patients with EGFR-mutated NSCLC worldwide, with an estimated prevalence of 30 to 40 percent compared to 10 to 15 percent in Europe and the United States.1 Despite treatment advances, approximately 30 percent of patients do not reach second-line therapy, making the choice of first treatment critical.2 Unfortunately, today, with 3rd generation TKI’s as the current standard of care , fewer than 20 percent of patients are alive five years after diagnosis3 which is less than other common cancers. MARIPOSA Asia cohort shows that survival can be significantly extended when using amivantamab and lazertinib as the first treatment line in patients of Asian descent compared to Osimertinib TKI monotherapy, extending the boundaries of the current survival rates, so desperately needed for advanced/metastatic EGFR positive NSCLC patients.

Given that 30% of patients never reach second-line therapy, how should clinicians rethink first-line treatment decisions in EGFR-mutated NSCLC?

Given 30% of patients never reach second-line therapy, clinicians should prioritize the most effective and durable first-line option. Starting with RYBREVANT® plus LAZCLUZE® helps delay resistance, preserves subsequent treatment options, and gives patients the best chance for long-term disease control.

Can you elaborate on how the triple mechanism of action—EGFR, MET inhibition and immune activation—translates into long-term durability compared to Osimertinib alone?

The triple mechanism of action with RYBREVANT® plus LAZCLUZE® simultaneously targets EGFR and MET pathways and engages the immune system. This combination has demonstrated a clinically meaningful and durable overall survival benefit compared to Osimertinib monotherapy, helping to delay resistance by addressing key drivers of treatment failure early, which supports sustained efficacy over the course of first-line therapy.

Were there notable differences in safety or tolerability among Asian patients, and how do you see prophylactic strategies influencing clinical practice?

The Asian population outcomes for both safety and efficacy are consistent with the overall global population in the MARIPOSA trial.

It is important to note that MARIPOSA trial did not include any prophylaxis for dermatological adverse events or Infusion Related Reactions (IRR), and yet still demonstrated highly significant and clinically meaningful outcomes, Anti-coagulation prophylaxis was added during the trial as a result of observed increase of Venous Thromboembolism (VTE) events in the RYBREVANT® plus LAZCLUZE® arm (but not observed with amivantamab monotherapy or in combination with chemotherapy). We have shown that prophylactic anti-coagulation use in the first 4 months of treatment reduces the VTE risk back to baseline for lung cancer patients. In addition to this, our Phase 2 studies SKIPPirr and COCOON have demonstrated that prophylactic approach for dermatological events and IRRs are highly effective and significantly reduce the frequency and severity of events of interest. We believe that the implementation of simple supportive care regimens into clinical practice will enable real world patients to further maximize their survival outcomes.

We will continue to evolve supportive care strategies to ensure the patients are supported on their journey, from prevention of adverse events to reactive treatment, as required. The aim is to maintain patients on therapy so they can maximise survival outcomes, whilst maintaining good quality of life. This should be the aim of all emerging therapies.

What are Johnson & Johnson’s plans for ensuring broad and equitable access to amivantamab plus lazertinib across Asia, where health-system infrastructure varies widely?

At Johnson & Johnson, we are deeply committed to ensuring that patients across Asia can benefit from innovative therapies like amivantamab plus lazertinib, especially in the EGFR-mutated non-small cell lung cancer setting, where the clinical unmet needs remain significant.

Recognizing the diversity of healthcare systems across the region, our access strategy is multifaceted. We are actively engaging with government stakeholders and national payers to pursue reimbursement pathways wherever feasible, aiming to integrate our therapy into public health systems and reach patients through sustainable coverage models.

In parallel, we are developing tailored Patient Access Programs (PAPs) to support affordability for patients in the self-pay segment - a substantial component of healthcare financing in many of our APAC markets. These programs are designed to reduce financial barriers and ensure that cost does not stand in the way of life-extending treatment.

Ultimately, our goal is clear: to maximize access and deliver innovative treatment choices for patients and families affected by lung cancer.

Looking ahead, how might these results shape the competitive landscape of EGFR-mutated lung cancer therapies, particularly in markets where Osimertinib is already the standard?

The overall survival results from MARIPOSA trial clearly demonstrate the clinical benefit of RYBREVANT® plus LAZCLUZE® in the first-line setting, thereby making it the Standard of Care in this treatment paradigm. Compared with Osimertinib monotherapy, this combination offers >12 months additional overall survival benefit, outmaneuvering resistance mechanisms, helping preserve chemotherapy for subsequent treatment options, thereby establishing a new benchmark for first-line EGFR-mutated NSCLC.

Ref:

1 Zhang YL, Yuan JQ, Wang KF, et al. The prevalence of EGFR mutation in patients with non-small cell lung cancer: a systematic review and meta-analysis. Oncotarget. 2016;7(48):78985-78993. doi:10.18632/oncotarget.12587

2 Roeper J, et al. Risk of not receiving 2nd line therapy is high in EGFR mt+ pts: Real world data of certified lung cancer centers on treatment sequence in EGFR mt+ pts. J Clin Oncol. 2018;36(suppl):e21220. doi:10.1200/JCO.2018.36.15_suppl.e21220

3 Sabari JK, Yu HA, Mahadevia PJ, et al. Overall survival in EGFR-mutant advanced non–small cell lung cancer treated with first-line osimertinib: a cohort study integrating clinical and biomarker data in the United States. J Thorac Oncol. Published online May 2, 2025. doi:10.1016/j.jtho.2025.04.010

Anthony Elgamal: Redefining First-Line Treatment in EGFR-Mutated Lung Cancer

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