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NSCLC — SCE Medical Oncology MCQ

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ModerateLung CancerNSCLCSCE Medical Oncology

A 55-year-old woman with stage IV NSCLC and an EGFR L858R mutation has been on osimertinib for 12 months with good response. She reports new persistent dry cough. CT shows subtle bilateral ground-glass changes but stable tumour. SpO2 96%. What is the key differential and next investigation?

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Correct answer: D — Osimertinib-related ILD — perform high-resolution CT, check KL-6/LDH, consider BAL and hold osimertinib

New respiratory symptoms with bilateral ground-glass opacities on CT in a patient on EGFR TKI should raise suspicion of drug-induced interstitial lung disease. HRCT can better characterise the pattern (NSIP, OP, DAD). KL-6 and SP-D are serum biomarkers elevated in ILD. Osimertinib should be held pending investigation. BAL excludes infection and can show lymphocytosis in drug-induced ILD. If confirmed, osimertinib is permanently discontinued.

Reference: BNF Osimertinib monograph; ESMO 2024 NSCLC Guidelines; Skeoch et al Chest 2017