How would you manage a patient with EGFR mutant adenocarcinoma of the lung on erlotinib with a single site of disease progression, but otherwise well-controlled disease?

This is a point of controversy. There are multiple reasonable options to consider for such a patient:

1. Keep going with tarceva and follow the lesion carefully. The NCCN guidelines actually acknowledge this approach for asymptomatic disease.
2. Use SRS or some other locally ablative approach to destroy the site of progression then continue with tarceva for the rest. There are two retrospective studies on this approach (both from poster discussion lung asco 2013) justifying it. There is also a pros...