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Lung: Adjuvant osimertinib (ADAURA)

Free question published 05 October 2026

RespiratoryAdjuvant osimertinib (ADAURA)

A 58-year-old never-smoker undergoes an R0 right upper lobectomy and systematic nodal dissection for a 3.5 cm adenocarcinoma, staged pT2aN1M0 (stage IIB). Molecular analysis confirms an EGFR exon 19 deletion. She recovers well, has WHO performance status 0, and adjuvant cisplatin-based chemotherapy is planned. With respect to subsequent targeted therapy, what is the most appropriate adjuvant management?

  1. AConsolidation durvalumab for 12 months
  2. BOsimertinib 80 mg once daily for up to 3 years
  3. CNo EGFR tyrosine kinase inhibitor; surveillance after chemotherapy
  4. DGefitinib for 2 years
  5. EOsimertinib 80 mg once daily continued indefinitely until recurrence

Why B is correct

The ADAURA trial randomised patients with completely resected stage IB-IIIA EGFR-mutated NSCLC (exon 19 deletion or L858R) to osimertinib 80 mg once daily or placebo until recurrence or completion of the trial regimen at 3 years. It demonstrated a marked disease-free survival benefit (HR 0.20 in stage IB-IIIA) and a subsequent overall survival benefit (HR 0.49). UK practice gives adjuvant osimertinib for up to 3 years.

And why the others are not

  • AConsolidation durvalumab applies to unresectable stage III NSCLC after chemoradiotherapy (PACIFIC), not to completely resected EGFR-mutated disease.
  • CWithholding an EGFR TKI forgoes the proven DFS and OS benefit of adjuvant osimertinib in this EGFR-mutated resected population.
  • DGefitinib is not the adjuvant agent supported by the practice-changing ADAURA data; osimertinib is the third-generation EGFR TKI used.
  • EADAURA capped treatment at 3 years; indefinite osimertinib is not the protocol-defined or licensed adjuvant duration.

Source ADAURA - Adjuvant osimertinib in resected EGFR-mutated stage IB-IIIA NSCLC — Tsuboi M, Herbst RS, John T, et al. Overall Survival with Osimertinib in Resected EGFR-Mutated NSCLC. N Engl J Med. 2023;389(2):137-147. (ADAURA; primary DFS: Wu YL et al, N Engl J Med 2020;383:1711-1723).

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