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EGFR-mutated NSCLC — SCE Respiratory MCQ

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ModerateLung cancerEGFR-mutated NSCLCSCE Respiratory

A 59-year-old never-smoker has metastatic lung adenocarcinoma with bone and pleural involvement. Molecular testing shows an EGFR exon 19 deletion; PD-L1 is 10% and performance status is 1. MRI brain shows two asymptomatic small metastases. Renal and liver function are normal. What is the most appropriate management?

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Correct answer: C — First-line EGFR tyrosine kinase inhibitor therapy

An activating EGFR mutation in metastatic non-squamous NSCLC makes first-line EGFR TKI therapy the best systemic option. Immunotherapy alone is tempting when PD-L1 is positive, but EGFR-driven tumours respond better to targeted therapy first. Molecular testing must be completed early because it changes the first-line plan.

Reference: NICE NG122 Lung cancer; NICE technology appraisals for EGFR-mutated NSCLC