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NSCLC — SCE Medical Oncology MCQ

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HardLung CancerNSCLCSCE Medical Oncology

A never-smoker with EGFR exon 19-deleted metastatic lung adenocarcinoma progresses after osimertinib. Repeat biopsy shows small-cell morphology, synaptophysin positivity and loss of RB1, while the original EGFR mutation persists. What is the most appropriate systemic backbone?

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Correct answer: A — Platinum plus etoposide, treating the acquired small-cell phenotype

The biopsy documents small-cell transformation, an EGFR-TKI resistance mechanism. Transformed tumours retain the founding EGFR mutation but behave clinically as SCLC; published cohorts support platinum-etoposide as the treatment backbone. Persistence of the EGFR mutation does not justify another EGFR TKI alone.

Reference: Clinical outcomes after small-cell transformation of EGFR-mutant NSCLC (Published February 2020): https://pmc.ncbi.nlm.nih.gov/articles/PMC7001776/