Alternating therapy with osimertinib and afatinib for treatment-naive patients with EGFR-mutated advanced non-small cell lung cancer: A single-group, open-label phase 2 trial (WJOG10818L)

•Alternation of osimertinib and afatinib was evaluated for patients with metastatic treatment-naïve EGFR-mutated NSCLC in this phase 2 trial.•Although the 12-month PFS probability was 70.2%, which did not meet the primary end point, the median PFS was 21.3 months suggesting the promising efficacy of this alternative therapy.•Our results are indicative of the feasibility of alternating therapy with osimertinib and afatinib.•The study treatment is effective even in patients with TP53 mutations or EGFR compound mutations from exploratory cfDNA analysis results.