skip to main content

NSCLC — SCE Medical Oncology MCQ

Instant feedback + full explanation. One question, done properly.

HardLung CancerNSCLCSCE Medical Oncology

A treatment-naive man has ALK-rearranged metastatic non-small-cell lung cancer and three small, asymptomatic brain metastases without mass effect. At the neuro-oncology MDT, local treatment can safely be deferred with close MRI review. Which systemic option treats both extracranial and intracranial disease?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Start alectinib and reassess the brain metastases early with MRI

Explanation lettering: B = shown as A · A = shown as B · E = shown as D · D = shown as E

E is correct. Alectinib is a NICE-recommended first-line ALK inhibitor with substantial intracranial activity. In an asymptomatic patient without mass effect, a specialist MDT may use the CNS-active TKI with early MRI surveillance and reserve radiotherapy for inadequate response or progression. Surgery is not required for every small metastasis, platinum chemotherapy and temozolomide are inferior to genotype-directed treatment, and routine whole-brain radiotherapy creates avoidable neurocognitive toxicity. Symptomatic lesions, haemorrhage, mass effect or diagnostic uncertainty would alter the local-treatment decision, so deferral is not automatic merely because ALK rearrangement is present.

Reference: NICE TA536 alectinib recommendations: https://www.nice.org.uk/guidance/ta536/chapter/1-Recommendations