How Does Tagrisso Stack Up to Other Lung Cancer Medications?

Chances are you know someone with lung cancer. Or you may have been diagnosed with it yourself. After all, it’s the second most common type of cancer. Of the different types of lung cancer, non-small cell lung cancer (NSCLC) is the most common type, and it has many treatment options aside from traditional chemotherapy, radiation, or surgery. 

Nowadays, we can identify and target specific mutations that contribute to cancer growth in a large percentage of people with lung cancer. One common mutation is the epidermal growth factor receptor (EGFR) mutation. 

If you have been told you have EGFR mutation-positive NSCLC, you may have had a discussion with your cancer specialist about medications that treat this type of cancer. Tagrisso (osimertinib) is one of these medications. It’s a popular choice for slowing down cancer growth. 

What is Tagrisso?

Tagrisso is a medication that treats EGFR mutation-positive NSCLC. It’s a type of kinase inhibitor that targets EGFR mutations. 

Tagrisso is relatively simple to take. It’s a pill taken by mouth once daily, with or without food. It’s usually taken long-term if you have advanced NSCLC. You could also take it for up to 3 years if you started taking it after surgery.

How does Tagrisso work?

EGFR is a type of kinase. Kinases are proteins that act as signals for cell growth. But when there are mutations in your body’s gene for EGFR, these signals are constantly turned on, which causes your cells to grow too much. This results in cancer growth.

Tagrisso turns off these signals and helps slow cancer cell growth. 

Is Tagrisso considered chemotherapy?

No. Tagrisso is not chemotherapy. It’s considered a targeted therapy medication. It targets EGFR mutations.

How effective is Tagrisso?

Tagrisso is a beneficial treatment for many people living with advanced NSCLC (cancer that can’t be removed by surgery or has spread to other parts of the body) with EGFR mutations. 

In a key clinical study, Tagrisso extended the time without seeing cancer growth by about 9 months compared to two other oral EGFR kinase inhibitors, Iressa (gefitinib) and Tarceva (erlotinib).

Tagrisso is also an effective second-choice option for people that are resistant to other oral EGFR inhibitors and move on to chemotherapy. In a different study, Tagrisso lengthened the time without seeing cancer growth by about 6 months compared to chemotherapy. 

It’s also a treatment option for people with earlier-stage NSCLC that can be removed by surgery. In another study, when taken after surgery, Tagrisso improved the odds of cancer not coming back by about 80%. 

More recent data shows even more promising results among people who previously had their cancer treated by surgery. A June 2023 study published in The New England Journal of Medicine found that Tagrisso significantly helps increase overall survival time. After 5 years of treatment, 88% of people taking Tagrisso (and 78% of people taking placebo) were still alive.

What are the side effects of Tagrisso?

Despite Tagisso’s results in clinical trials, no medication is without its side effects. The most common side effects of Tagrisso include:

• Bone or muscle pain

• Cough

• Diarrhea

• Dry skin

• Rash

• Feeling tired

• Low platelets

• Low red blood cells

• Low white blood cells

• Mouth sores

• Nail changes, including tenderness, brittle nails, and possible nail loss

Tagrisso has also been linked to more severe side effects, although these are rare. You should reach out to your care team or seek medical attention if you’re experiencing any of these side effects:

• Cardiomyopathy, which includes symptoms like shortness of breath, feeling tired, and swelling

• Cutaneous vasculitis, which can cause red spots, bumps, or blisters on the skin 

• Eye inflammation

• Lung inflammation

• QTc prolongation, an irregular heartbeat that can cause symptoms like lightheadedness and fainting

• Severe rash

Which medications are comparable to Tagrisso?

In addition to Tagrisso, there are five other oral EGFR kinase inhibitors that are used for NSCLC. These include:

• Iressa

• Tarceva

• Gilotrif (afatinib)

• Vizimpro (dacomitinib)

• Exkivity (mobocertinib)

There are also two intravenous EGFR inhibitors, called Rybrevant (amivantamab) and Portrazza (necitumumab). These are different from the oral EGFR kinase inhibitors listed above. They’re monoclonal antibodies that are given as an infusion into the vein. However, Portrazza isn’t recommended by current cancer guidelines. It’s meant to be used with chemotherapy, but it doesn’t add much benefit and worsens the amount of side effects. 

Let’s discuss how these medications stack up to Tagrisso in the different stages of NSCLC treatment. 

First-choice option — after surgery

Tagrisso is currently the only EGFR kinase inhibitor that’s approved for use after surgery for EGFR mutation-positive NSCLC.

First-choice option — advanced NSCLC

Tagrisso is a preferred first-choice option for advanced, EGFR mutation-positive NSCLC. It appears to increase time without cancer growth compared to Iressa, Gilotrif, or Tarceva. 

However, with the exception of Exkivity, all of the oral EGFR kinase inhibitors mentioned above are still possible go-to treatment options for this type of cancer. Exkivity is used later on in treatment if you have a special EGFR mutation — more on this later.

Other options include combining a vascular endothelial growth factor (VEGF) inhibitor with an EGFR inhibitor, such as Cyramza (ramucirumab) or Avastin (bevacizumab). VEGF inhibitors block the growth of blood vessels that feed cancer cells. 

Second-choice option and beyond — advanced NSCLC

Tagrisso is a next-choice option to consider if you have advanced NSCLC and your cancer got worse while taking a different oral EGFR kinase inhibitor. 

Tagrisso also passes the blood-brain barrier, a network of blood vessels and tissues that control what substances are allowed into the brain. Other oral EGFR kinase inhibitors can’t cross this barrier, so Tagrisso is an option if your cancer has spread to the brain. 

Interestingly, Tagrisso is also a preferred choice if you’re found to have a T790M mutation. This mutation means your cancer became resistant to other oral EGFR kinase inhibitors. Tagrisso is able to fight the T790M mutation.

What are the alternatives to Tagrisso if my cancer gets worse?

If your cancer grows (gets worse) while taking Tagrisso, it becomes less important to target the EGFR mutation. At that point, you typically have more options to consider. 

Here are examples of next-choice options:

• Chemotherapy, such as carboplatin plus Abraxane (albumin-bound paclitaxel)

• Immunotherapy, such as Yervoy (ipilimumab) plus Opdivo (nivolumab)

• Immunotherapy plus chemotherapy, such as Keytruda (pembrolizumab) plus carboplatin and pemetrexed

• Combining targeted therapies, such as Gilotrif plus Erbitux (cetuximab)

• Immunotherapy plus chemotherapy and targeted therapy, such as Tecentriq (atezolizumab) plus carboplatin, paclitaxel, and Avastin

Researchers are constantly discovering new EGFR mutations. Another mutation, known as the exon 20 insertion mutation, doesn’t seem to respond to typical oral EGFR kinase inhibitors. If you have this mutation, you may be treated as if you have no targetable mutations. Treatment with chemotherapy plus immunotherapy is preferred in this case. But newer EGFR inhibitors — like Exkivity or Rybrevant — could also be tried. 

How to save on Tagrisso

There are ways to save on Tagrisso, which is only available as a brand-name medication. GoodRx can help you navigate between patient assistance programs and copay savings cards to save money on your prescription.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Tagrisso’s patient assistance program, which offers the medication free of cost.

• Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $0 for Tagrisso using a savings card from the manufacturer.

Why trust our experts?

Written by:

Rachel Feaster, PharmD, BCOP, BCPS

Rachel Feaster has over 10 years of professional experience in ambulatory, inpatient, pharmacogenomics, and oncology care. She is board certified in oncology and pharmacotherapy.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

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