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Unresectable stage III EGFR-mutated non-small-cell lung cancer after chemoradiotherapy — SCE Respiratory MCQ

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HardOncologyUnresectable stage III EGFR-mutated non-small-cell lung cancer after chemoradiotherapySCE Respiratory

A 63-year-old never-smoker has stage IIIC (T2bN3M0) lung adenocarcinoma. Thoracic multidisciplinary review concludes that the disease is unresectable. Comprehensive genomic testing demonstrates an EGFR exon 21 L858R substitution; ALK and ROS1 testing is negative. The tumour proportion score for PD-L1 is 80%. Because she was considered unsuitable for concurrent treatment, she received four cycles of carboplatin and pemetrexed followed by radical thoracic radiotherapy, 60 Gy in 30 fractions. Six weeks after completing radiotherapy, CT shows a partial response with no new lesions, and brain MRI shows no intracranial metastases. She has WHO performance status 1, no clinical or radiological pneumonitis, and satisfactory renal, hepatic and cardiac assessments. Which post-chemoradiotherapy oncological strategy is most appropriate?

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Correct answer: E — Commence osimertinib maintenance treatment

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

This patient has unresectable stage III NSCLC with a sensitising EGFR exon 21 L858R mutation and no progression after definitive platinum-based chemoradiotherapy. NICE TA1156 recommends osimertinib in precisely this setting. The recommendation is not restricted to concurrent chemoradiotherapy; the supporting LAURA population included both concurrent and sequential treatment. Her absence of pneumonitis or another stated contraindication permits treatment. A is no longer the preferred strategy for an eligible patient, although surveillance was the previous standard comparator and remains appropriate if osimertinib is contraindicated or declined. B is attractive because PD-L1 expression is 80%. However, NICE's durvalumab recommendation requires prior concurrent platinum-based chemoradiotherapy, whereas this patient received sequential treatment. Moreover, NICE concluded that durvalumab has limited effectiveness in EGFR-mutated disease and that its use in this population is declining. D confuses the post-chemoradiotherapy stage III indication with first-line therapy for advanced or metastatic EGFR-mutated NSCLC. Additional platinum–pemetrexed is not the recommended consolidation regimen after completed definitive chemoradiotherapy. E similarly extrapolates from metastatic PD-L1-high NSCLC; pembrolizumab maintenance is not the recommended post-chemoradiotherapy strategy here, and the actionable EGFR mutation is the decisive biomarker.

Reference: Osimertinib for treating EGFR mutation-positive unresectable locally advanced non-small-cell lung cancer after platinum-based chemoradiotherapy (21 May 2026) — https://www.nice.org.uk/guidance/ta1156/chapter/1-Recommendations Durvalumab for maintenance treatment of unresectable non-small-cell lung cancer after platinum-based chemoradiation (22 June 2022) — https://www.nice.org.uk/guidance/ta798/chapter/1-Recommendations Osimertinib for treating EGFR mutation-positive unresectable locally advanced non-small-cell lung cancer after platinum-based chemoradiotherapy: committee discussion (21 May 2026) — https://www.nice.org.uk/guidance/ta1156/chapter/3-Committee-discussion