80yr female, ECOG 0 with stage IV EGFR exon 21 L 858R lung adeno, PDL1 5%. Just completed palliative RT for painful right chest wall lesion. Would you use osimertinib alone or with carbo/Pem?
Great question. Obviously both are approved. It sounds like with ECOG 0 and L858R I would lean towards upfront chemotherapy plus Osimertinib. However, given patient’s age, discuss patient preference as well on whether they would be willing to undergo chemotherapy. It would be helpful to know what the disease burden is like, if not too high, could go with single agent, osimertinib and save chemotherapy for at progression.
