How would you treat a young patient with an EGFR 19 deletion and a locally advanced lung mass who had a brain metastasis that was resected?

The technically correct, textbook answer would be 1st line EGFR therapy for metastatic NSCLC, which would be osimertinib + carboplatin/pemetrexed (FLAURA2) or amivantamab/lazertinib (MARIPOSA). However, given the unique circumstances here, I would treat this patient slightly differently.

I've written...

I think there are a few ways to go about this. How large is the lung mass, and are there any gross nodes? If lung mass and 1-2 limited nodes, you could consider osi-chemo for 2-3 months to address systemic risk and cytoreduce the thoracic disease, and you could offer SBRT in 5 fractions to the resid...

Osimertinib plus pemetrexed and carboplatin, as in FLAURA2. Amivantamab plus lazertinib is also ok but probably not as well-tolerated.