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CNS Oligoprogression EGFR — SCE Medical Oncology MCQ

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ModerateLung CancerCNS Oligoprogression EGFRSCE Medical Oncology

A 58-year-old woman with NSCLC harbouring an EGFR exon 19 deletion on osimertinib develops isolated CNS progression (2 new brain metastases) while systemic disease remains controlled. What is the preferred approach?

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Correct answer: C — Continue osimertinib and add SRS to the brain metastases — this is oligoprogression in the CNS

Isolated CNS progression on osimertinib (oligoprogression) while systemic disease remains controlled is best managed by continuing osimertinib (which has good baseline CNS activity) and adding local CNS-directed therapy (SRS for limited brain metastases). This extends time on effective systemic therapy. If CNS progression is more extensive, dose escalation to osimertinib 160 mg may be considered (off-label, BLOOM study data). Stopping a systemically effective TKI solely for isolated CNS progression is suboptimal.

Reference: ESMO 2024 NSCLC; ESMO Brain Metastases Guidelines