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Oligometastatic NSCLC — SCE Medical Oncology MCQ

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HardLung CancerOligometastatic NSCLCSCE Medical Oncology

A patient with EGFR exon-19-deleted metastatic NSCLC has had 18 months of systemic control on osimertinib. Restaging shows growth only in one adrenal metastasis; brain and all other sites remain controlled, symptoms are absent and repeat molecular sampling shows no immediately actionable new driver. What is the most appropriate MDT strategy?

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Correct answer: E — Ablate the adrenal lesion and continue osimertinib within an expert MDT pathway

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

B is correct. This is oligoprogression: a limited resistant clone has escaped while the remaining disease is still suppressed. European specialist guidance supports considering definitive local therapy to all progressing sites while continuing the active targeted agent in carefully selected patients, although evidence remains limited and trials are preferred. Immediate wholesale systemic change can discard ongoing osimertinib benefit. Adding immunotherapy to osimertinib is not a standard rescue strategy and carries toxicity concerns, while waiting for widespread progression sacrifices a potentially useful treatment window. Biopsy is valuable when feasible because a new resistance mechanism may change the plan.

Reference: ESMO oncogene-addicted NSCLC guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC11648200/