2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/2iy5wruuedsh6.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/00yc7rcvua6a7.js","/_next/static/immutable/chunks/37ktb71aq3480.js","/_next/static/immutable/chunks/2d50b-7eu4558.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/2d6noqpp6ehas.js","/_next/static/immutable/chunks/1sx186c93bpzg.js","/_next/static/immutable/chunks/3dc-1n866s65i.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2w1bvggzb0ga8.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T6c4,Clinical guidelines recommend upfront osimertinib monotherapy for asymptomatic brain metastases (BM) in epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC), despite a lack of randomised trial evidence. We conducted two randomised phase II trials, OUTRUN and LUOSICNS, to evaluate the efficacy and safety of upfront stereotactic radiosurgery (SRS) plus osimertinib versus osimertinib in this patient population. Participants with up to ten BM amenable to SRS were randomised 1:1 to SRS followed by osimertinib (80mg daily) or osimertinib monotherapy. SRS was delivered as a single or multi-fraction regimen. The primary endpoint was 12-month intracranial progression-free survival (ic-PFS). Key secondary endpoints include overall survival (OS), patterns of intracranial progression, and safety. Data from both trials were prospectively pooled for a joint analysis. Overall, 79 participants were randomised. At a median follow-up of 39.0 months, 12-month ic-PFS was not significantly different between SRS plus osimertinib (n = 39) over osimertinib monotherapy (n = 40) (11%, 95% CI, -10% to 32%, P=.31; median ic-PFS 21.9 versus 17.2 months). Median OS was 46.1 versus 29.1 months. Among those with intracranial progression, 35% in the SRS plus osimertinib group and 57% in the osimertinib monotherapy group underwent SRS at progression. Grade 3/4 radionecrosis occurred in 5% of participants treated with SRS plus osimertinib. Adding upfront SRS to osimertinib did not significantly improve 12-month ic-PFS in EGFR mutant NSCLC with BM. This represents the first randomised evidence supporting the use of osimertinib monotherapy as upfront therapy in minimally symptomatic patients with low burden BM.31:Tb05,Lung cancer in nonsmoking individuals (defined as people who have smoked fewer than 100 cigarettes in their lifetime) accounts for 15% to 20% of all lung cancer cases worldwide. In the US, the annual incidence of lung cancer in nonsmoking individuals is 14.4 to 20.8 per 100 000 person-years in females and 4.8 to 12.7 per 100 000 person-years in males. Most lung cancers in nonsmoking individuals are histologically adenocarcinomas (60%-80%) with the remainder being squamous or adenosquamous (10%-20%) and rarely small cell lung cancer (<10%). Risk factors include exposure to passive smoking, radon exposure, air pollution, asbestos, and history of lung cancer in a first-degree family member. Therapeutically targetable genomic variants, such as EGFR mutations or ALK gene rearrangements, are more common in tumors from nonsmoking individuals compared with those with a smoking history (defined as people who currently or formerly smoked) (43% vs 11% for EGFR and 12% vs 2% for ALK). In contrast, tumor mutation burden, the number of somatic mutations in a tumor cell, is lower in lung cancer among nonsmoking individuals (0-3 mutations/megabase [Mb] vs 0-30 mutations/Mb). Similar to individuals with a history of smoking, nonsmoking individuals with lung cancer may present with wheeze, chest pain, dyspnea, hemoptysis, or symptoms attributable to metastatic disease (eg, bone pain and headache) or be diagnosed with incidentally detected disease. The US Preventive Services Task Force does not currently recommend lung cancer screening with low-dose computed tomographic scans for nonsmoking individuals, although screening guidelines vary globally. Treatment typically involves a combination of surgery, radiotherapy, and systemic therapies depending on stage, performance status, and molecular features of the tumor. Comprehensive next-generation sequencing should be performed on stage Ib to IIIa lung cancer tumor tissue from nonsmoking individuals because actionable genomic alterations, such as EGFR mutations or ALK gene rearrangements, are treated with targeted therapy such as the tyrosine kinase inhibitors osimertinib or lorlatinib, respectively. Median survival among nonsmoking individuals with advanced non-small cell lung cancer (stage IIIb or higher) and actionable genomic alterations can exceed 3 to 5 years, while survival without these genomic alterations is similar to lung cancer in people with a history of smoking (1-2 years). Lung cancer in nonsmoking individuals accounts for 15% to 20% of lung cancer cases worldwide. Among patients with lung cancer, nonsmoking individuals are more likely to have genomic alterations such as EGFR mutations or ALK gene rearrangements, and these patients have improved survival when treated with tyrosine kinase inhibitors compared with chemotherapy.32:T1000, Importance Lung cancer in nonsmoking individuals (defined as people who have smoked fewer than 100 cigarettes in their lifetime) accounts for 15% to 20% of all lung cancer cases worldwide. In the US, the annual incidence of lung cancer in nonsmoking individuals is 14.4 to 20.8 per 100 000 person-years in females and 4.8 to 12.7 per 100 000 person-years in males. Observations Most lung cancers in nonsmoking individuals are histologically adenocarcinomas (60%-80%) with the remainder being squamous or adenosquamous (10%-20%) and rarely small cell lung cancer (&lt;10%). Risk factors include exposure to passive smoking, radon exposure, air pollution, asbestos, and history of lung cancer in a first-degree family member. Therapeutically targetable genomic variants, such as EGFR mutations or ALK gene rearrangements, are more common in tumors from nonsmoking individuals compared with those with a smoking history (defined as people who currently or formerly smoked) (43% vs 11% for EGFR and 12% vs 2% for ALK ). In contrast, tumor mutation burden, the number of somatic mutations in a tumor cell, is lower in lung cancer among nonsmoking individuals (0-3 mutations/megabase [Mb] vs 0-30 mutations/Mb). Similar to individuals with a history of smoking, nonsmoking individuals with lung cancer may present with wheeze, chest pain, dyspnea, hemoptysis, or symptoms attributable to metastatic disease (eg, bone pain and headache) or be diagnosed with incidentally detected disease. The US Preventive Services Task Force does not currently recommend lung cancer screening with low-dose computed tomographic scans for nonsmoking individuals, although screening guidelines vary globally. Treatment typically involves a combination of surgery, radiotherapy, and systemic therapies depending on stage, performance status, and molecular features of the tumor. Comprehensive next-generation sequencing should be performed on stage Ib to IIIa lung cancer tumor tissue from nonsmoking individuals because actionable genomic alterations, such as EGFR mutations or ALK gene rearrangements, are treated with targeted therapy such as the tyrosine kinase inhibitors osimertinib or lorlatinib, respectively. Median survival among nonsmoking individuals with advanced non–small cell lung cancer (stage IIIb or higher) and actionable genomic alterations can exceed 3 to 5 years, while survival without these genomic alterations is similar to lung cancer in people with a history of smoking (1-2 years). Conclusions Lung cancer in nonsmoking individuals accounts for 15% to 20% of lung cancer cases worldwide. Among patients with lung cancer, nonsmoking individuals are more likely to have genomic alterations such as EGFR mutations or ALK gene rearrangements, and these patients have improved survival when treated with tyrosine kinase inhibitors compared with chemotherapy. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"osimertinib: generic Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on osimertinib (generic). Clinician-written summaries and actionable practice insights. 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tirumotecan","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"generic","value":"selpercatinib","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"generic","value":"sotorasib","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"generic","value":"tepotinib","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"generic","value":"trametinib","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"generic","value":"trastuzumab deruxtecan","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"generic","value":"zenocutuzumab","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"modality","value":"Antibody-Drug Conjugate","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"modality","value":"Bispecific Antibody","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"modality","value":"Tyrosine Kinase Inhibitor","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"warning","value":"Full text was paywalled and not available; all structured data are derived from the abstract, reference list, and publisher page only — specific trial outcomes, hazard ratios, and patient-level data could not be verified.","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"warning","value":"Sex of the studied population is not reported in the available abstract text and was omitted from tags.","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"warning","value":"Study design classified as 'Narrative Review'; level of evidence set to 5 accordingly. No single sample size applies to this review.","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00253-5","tag_type":"warning","value":"This is a narrative review series paper, not a primary study; the 'practice_changing' impact flag reflects the breadth of evidence synthesized across multiple approved therapies, not a single trial result.","value_numeric":null}],"summaries":{"what_studied":"This review (second in a Lancet Respiratory Medicine series) summarizes the current landscape of biomarker-matched targeted therapies in advanced NSCLC, covering established drivers (EGFR, ALK, ROS1, KRAS, BRAF, RET, HER2, MET, NTRK) and emerging targets (NRG1 fusions, MTAP loss, SMARCA4 deficiency), including newer TKI generations, bispecific antibodies, and antibody-drug conjugates (ADCs).","key_result":"Across established drivers, next-generation TKIs, bispecific antibodies (e.g., amivantamab–lazertinib), and ADCs (e.g., trastuzumab deruxtecan, sacituzumab tirumotecan) have improved response durability, intracranial disease control, and in some settings overall survival; however, acquired resistance, tumor heterogeneity, lineage plasticity, and off-target escape remain key barriers to durable benefit.","limitations":"Full text was not accessible — the summary is based solely on the abstract and reference list, which limits extraction of specific outcome data, patient numbers, and granular trial results. This is a narrative review series paper, not a primary study, so no single efficacy estimate applies.","practice_takeaway":"For advanced NSCLC, comprehensive upfront molecular profiling and timely biomarker testing are essential, as an expanding number of drivers now have matched therapies that outperform chemotherapy. Repeat tissue biopsy or circulating-tumor DNA testing at progression is increasingly important to identify actionable resistance mechanisms and guide next-line therapy."}},{"doi":"10.1016/j.lungcan.2026.109604","pmid":"42691830","title":"Clinical outcomes and genomic features of uncommon EGFR exon 19 deletion subtypes in osimertinib-treated non-small cell lung cancer","journal_title":"Lung Cancer","journal_issn":"0169-5002","published_at":"2026-08-31T00:00:00.000Z","url":"https://doi.org/10.1016/j.lungcan.2026.109604","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-10T06:20:01.364Z","updated_at":"2026-09-10T06:20:01.364Z","tags":[{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"brand","value":"Tagrisso","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"condition","value":"EGFR Exon 19 Deletion-Positive NSCLC","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"condition","value":"Non-Small Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"generic","value":"osimertinib","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"modality","value":"EGFR Tyrosine Kinase Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"sample_size","value":"n=111","value_numeric":111},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"warning","value":"Genomic co-alteration data (RBM10, CDKN2A/B, MYC) derive from public databases, not the primary clinical cohort, so direct causal links to outcomes cannot be established.","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"warning","value":"Sex distribution is not explicitly reported in the abstract; 'mixed' is assumed based on typical NSCLC cohort composition.","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"warning","value":"The impact_flag 'safety_signal' is used loosely here to flag prognostic risk heterogeneity — this is not a drug safety/adverse event signal in the traditional sense.","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109604","tag_type":"warning","value":"The L747_A750delinsP subgroup contains only 4 patients; survival findings for this subtype should be interpreted with caution despite statistical significance.","value_numeric":null}],"summaries":{"what_studied":"This multicenter retrospective study compared progression-free survival (PFS) and overall survival (OS) among EGFR exon 19 deletion subtypes in 111 patients with advanced NSCLC treated predominantly with first-line osimertinib (86.5%), and used whole-exome sequencing from AACR GENIE and MSK datasets to characterize co-occurring genomic alterations.","key_result":"Non-E746_A750del subtypes (n=25) had shorter median PFS vs. E746_A750del (n=86): 14.3 vs. 20.6 months (p<0.05). The L747_A750delinsP subtype (n=4) showed the worst outcomes — median PFS 3.5 vs. 20.6 months and median OS 11.8 vs. 48.5 months compared to E746_A750del (both p<0.001) — and was genomically characterized by frequent CDKN2A/B homozygous deletions and MYC amplifications.","limitations":"- The L747_A750delinsP subgroup is very small (n=4), limiting statistical reliability and generalizability.\n- Retrospective, multicenter design introduces potential selection and ascertainment biases.\n- Genomic co-alteration analyses relied on external public databases rather than the clinical cohort itself.","practice_takeaway":"Clinicians should be aware that non-E746_A750del EGFR exon 19 deletions — especially L747_A750delinsP — may signal a high-risk group with markedly worse outcomes on osimertinib. Consider closer monitoring and early investigation of resistant mechanisms or clinical trial enrollment for patients harboring these uncommon subtypes."}},{"doi":"10.1016/j.lungcan.2026.109590","pmid":"42664544","title":"Adding immunotherapy to chemotherapy may improve survival after SCLC transformation in EGFR-mutant NSCLC: a multicenter real-world study","journal_title":"Lung Cancer","journal_issn":"0169-5002","published_at":"2026-08-23T00:00:00.000Z","url":"https://doi.org/10.1016/j.lungcan.2026.109590","source_score":6,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-29T06:19:11.203Z","updated_at":"2026-08-29T06:19:11.203Z","tags":[{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"brand","value":"Imfinzi","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"brand","value":"Tagrisso","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"brand","value":"Tecentriq","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"condition","value":"EGFR-Mutant Non-Small Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"condition","value":"Small Cell Lung Cancer Transformation","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"generic","value":"atezolizumab","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"generic","value":"carboplatin","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"generic","value":"durvalumab","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"generic","value":"etoposide","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"generic","value":"osimertinib","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"modality","value":"EGFR Tyrosine Kinase Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"modality","value":"Immune Checkpoint Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"modality","value":"Platinum-Based Chemotherapy","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"sample_size","value":"n=59","value_numeric":59},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"warning","value":"Median PFS2 is reported for the overall post-transformation cohort only; PFS2 by treatment arm is not separately reported in the abstract, limiting comparison of progression-free outcomes between CE alone and CE plus immunotherapy.","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109590","tag_type":"warning","value":"The immunotherapy group was small (n=16) and heterogeneous (three different ICI regimens), which limits confidence in the survival benefit estimate. The 'practice_changing' flag reflects potential clinical impact but should be interpreted cautiously pending prospective validation.","value_numeric":null}],"summaries":{"what_studied":"This multicenter retrospective cohort study (26 centers, 2016–2025) evaluated survival outcomes in 59 patients with biopsy-proven SCLC transformation after EGFR-TKI therapy, comparing carboplatin/etoposide (CE) alone versus CE plus immune checkpoint inhibitors (atezolizumab, durvalumab, or durvalumab/osimertinib) post-transformation.","key_result":"Adding immunotherapy to CE was associated with significantly longer post-transformation median OS-2 (17.0 vs. 9.0 months; HR 0.327, 95% CI 0.139–0.767; p=0.026) and higher ORR (71.4% vs. 37.8%); overall median OS-2 was 11.0 months and median OS from metastatic diagnosis was 38.0 months.","limitations":"- Retrospective design with inherent selection bias; immunotherapy group was small (n=16) and not randomized.\n- Mixed immunotherapy agents (atezolizumab, durvalumab, durvalumab+osimertinib) preclude conclusions about individual regimens.\n- No biomarker data (e.g., PD-L1, TMB) to guide patient selection.","practice_takeaway":"Consider adding an immune checkpoint inhibitor to carboplatin/etoposide for patients with EGFR-mutant NSCLC who undergo SCLC transformation, as this may roughly double post-transformation survival. Systematic re-biopsy at TKI progression is essential to confirm histologic transformation before selecting therapy."}},{"doi":"10.1111/1759-7714.70379","pmid":"42601812","title":"Exceptional Response of\n HER2\n ‐Positive Breast Cancer to Osimertinib: A Case Report","journal_title":"Thoracic Cancer","journal_issn":"1759-7706","published_at":"2026-08-14T00:00:00.000Z","url":"https://doi.org/10.1111/1759-7714.70379","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-26T06:20:02.645Z","updated_at":"2026-08-26T06:20:02.645Z","tags":[{"paper_doi":"10.1111/1759-7714.70379","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"brand","value":"Tagrisso","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"condition","value":"EGFR-Mutant Non-Small Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"condition","value":"HER2-Positive Breast Cancer","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"generic","value":"osimertinib","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"modality","value":"EGFR Tyrosine Kinase Inhibitor","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"sample_size","value":"n=1","value_numeric":1},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"study_design","value":"Case Report","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"warning","value":"Baseline HER2 FISH was not performed, so it is unknown whether HER2 amplification was present before osimertinib; post-treatment biopsy was obtained after a six-month drug-free interval.","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"warning","value":"Only one patient reported; findings cannot be generalized or used to guide treatment decisions.","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"warning","value":"The exact mechanism (osimertinib vs. its metabolite AZ5104 vs. spontaneous tumor biology) is unproven; no functional validation was performed.","value_numeric":null},{"paper_doi":"10.1111/1759-7714.70379","tag_type":"warning","value":"The paper references two similar 2026 case reports of osimertinib-associated DCIS regression, suggesting an emerging pattern, but evidence remains anecdotal.","value_numeric":null}],"summaries":{"what_studied":"An 83-year-old woman with synchronous EGFR L858R-mutant lung adenocarcinoma (stage IVB) and HER2 IHC 3+ invasive breast cancer (stage IIA) was treated with osimertinib monotherapy; breast cancer response was observed over 27 months without dedicated HER2-directed therapy.","key_result":"The breast lesion shrank from 31×20 mm to 13×10 mm at 3 months and showed sustained metabolic response at 21 months (SUVmax 0.99 vs. 7.55 at baseline); postmortem biopsy confirmed Grade 3 therapeutic effect with HER2 amplification (HER2/CEP17 ratio 3.16), Ki-67 drop from 20% to 10%, and negative pAKT/pERK.","limitations":"- No baseline HER2 FISH, so pre-treatment amplification status cannot be compared.\n- Serial tissue or liquid biopsy was unavailable; clonal evolution and resistance mechanisms could not be tracked.\n- Single case without functional validation; findings are hypothesis-generating only.","practice_takeaway":"This case does **not** support using osimertinib as a substitute for established HER2-directed therapy in breast cancer. Clinicians managing synchronous EGFR-mutant lung and HER2-positive breast cancers should be aware of this possible off-target effect, but breast cancer treatment decisions should follow current evidence-based guidelines."}},{"doi":"10.1016/j.lungcan.2026.109558","pmid":null,"title":"Biology, detection, and management of incidental pulmonary nodules: the emerging role of targeted treatments. A review of the current literature and future perspectives","journal_title":"Lung Cancer","journal_issn":"0169-5002","published_at":"2026-08-03T00:00:00.000Z","url":"https://doi.org/10.1016/j.lungcan.2026.109558","source_score":5,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-08-08T13:23:33.481Z","updated_at":"2026-08-08T13:23:33.481Z","tags":[{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"brand","value":"Tagrisso","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"condition","value":"Lung Adenocarcinoma","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"condition","value":"Non-Small Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"condition","value":"Pulmonary Nodule","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"generic","value":"aumolertinib","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"generic","value":"osimertinib","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"modality","value":"EGFR Tyrosine Kinase Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"warning","value":"Aumolertinib is referenced via a conference abstract (Huang CB, JTHO 2024) — clinical data on its use for residual GGN lesions should be interpreted with caution.","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"warning","value":"Full text was not accessible; structured data was extracted from the abstract, highlights, keywords, and reference list only — quantitative outcomes cannot be confirmed.","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"warning","value":"Sample size is not applicable for this review article and has been omitted.","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"warning","value":"Sex of the studied population is not reported in the available text.","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109558","tag_type":"warning","value":"Study design tagged as 'Narrative Review' based on the article type designation and methodology described; no systematic search protocol was reported.","value_numeric":null}],"summaries":{"what_studied":"This narrative review covers the classification, prevalence, detection, risk stratification, and management of incidental pulmonary nodules (IPNs), with a focus on oncogenic driver mutations (especially EGFR) and the emerging role of targeted therapies such as EGFR-TKIs in managing oncogene-driven IPNs.","key_result":"Most IPNs are benign, but a subset represent early-stage lung cancer. EGFR mutations are enriched in ground-glass nodules (GGNs), and early evidence suggests EGFR-TKIs (e.g., osimertinib, aumolertinib) may suppress progression of residual GGN lesions after resection. Immunotherapy shows limited activity in GGN-type lesions, particularly those with EGFR/ALK alterations.","limitations":"- Full text was not available; conclusions are based on the abstract, highlights, and reference list only.\n- As a narrative review, it is subject to selection bias and does not provide pooled quantitative estimates.\n- Most cited treatment data come from small case series, single-arm phase II trials, or retrospective studies rather than completed randomized controlled trials.","practice_takeaway":"When managing patients with residual or synchronous GGNs after lung resection, test for EGFR mutations — EGFR-TKIs are an emerging option for EGFR-mutant nodules and are under active investigation in ongoing phase II trials. Immunotherapy is unlikely to benefit GGN lesions, especially in EGFR/ALK-positive cases."}},{"doi":"10.1016/j.lungcan.2026.109501","pmid":"42361644","title":"Durvalumab plus etoposide–platinum in patients with epidermal growth factor receptor (EGFR)-mutated advanced NSCLC and neuroendocrine transformation after first-line osimertinib: ORCHARD","journal_title":"Lung Cancer","journal_issn":"0169-5002","published_at":"2026-06-18T00:00:00.000Z","url":"https://doi.org/10.1016/j.lungcan.2026.109501","source_score":10,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-28T13:27:06.742Z","updated_at":"2026-06-28T13:27:06.742Z","tags":[{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"brand","value":"Imfinzi","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"brand","value":"Tagrisso","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"condition","value":"Large Cell Neuroendocrine Carcinoma","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"condition","value":"Neuroendocrine Transformation","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"condition","value":"Non-Small Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"condition","value":"Small Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"generic","value":"durvalumab","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"generic","value":"etoposide","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"generic","value":"osimertinib","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"modality","value":"PD-L1 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"modality","value":"Platinum-Based Chemotherapy","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"modality","value":"Topoisomerase II Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"sample_size","value":"n=14","value_numeric":14},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"study_design","value":"Phase 2 Platform Trial (Single-Arm Module)","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"warning","value":"Platform trial module design may introduce patient selection differences compared to a standalone RCT.","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"warning","value":"Sample size of only 14 patients makes all efficacy estimates highly uncertain and limits any firm conclusions.","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"warning","value":"The primary endpoint used an 80% confidence interval rather than the conventional 95%, which is non-standard and should be interpreted cautiously.","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109501","tag_type":"warning","value":"The study is single-arm with no control group, so the incremental benefit of durvalumab over etoposide-platinum alone cannot be determined.","value_numeric":null}],"summaries":{"what_studied":"This phase 2 platform study (ORCHARD) evaluated durvalumab 1,500 mg IV Q3W plus etoposide-platinum Q3W (up to 4 cycles) in 14 patients with EGFR-mutated advanced NSCLC who developed neuroendocrine transformation (SCLC or large cell neuroendocrine carcinoma) after progression on first-line osimertinib.","key_result":"Confirmed ORR was 43% (80% CI: 24–63%; 6 partial responses); median DoR 4.3 months; median PFS 4.2 months (95% CI: 3.0–5.6); median OS 10.2 months (95% CI: 4.3–16.8). Grade ≥3 AEs occurred in 64% of patients, most commonly neutropenia.","limitations":"Extremely small sample size (n=14) limits statistical power and generalizability. Single-arm design with no comparator group. The 80% CI used for the primary ORR endpoint is non-standard and may overstate precision.","practice_takeaway":"Durvalumab plus etoposide-platinum yields a modest response (~43% ORR) in neuroendocrine-transformed EGFR-mutated NSCLC post-osimertinib, but responses are short-lived (median ~4 months) and most patients progress or die within a year. This regimen may serve as a bridge option while better therapies are sought for this rare resistance mechanism."}},{"doi":"10.1016/j.lungcan.2026.109486","pmid":null,"title":"Osimertinib after definitive CRT in unresectable stage III EGFR-mutated NSCLC: safety outcomes from the phase III LAURA study","journal_title":"Lung Cancer","journal_issn":"0169-5002","published_at":"2026-06-06T00:00:00.000Z","url":"https://doi.org/10.1016/j.lungcan.2026.109486","source_score":11,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-06-11T13:42:36.788Z","updated_at":"2026-06-11T13:42:36.788Z","tags":[{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"brand","value":"Tagrisso","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"condition","value":"Non-Small Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"condition","value":"Unresectable Stage III NSCLC","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"generic","value":"osimertinib","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"modality","value":"Chemoradiotherapy","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"modality","value":"EGFR Tyrosine Kinase Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"warning","value":"Sample size tag omitted as total N was not present in the provided source text.","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"warning","value":"Sex tag omitted as it was not reported in the provided source text.","value_numeric":null},{"paper_doi":"10.1016/j.lungcan.2026.109486","tag_type":"warning","value":"The provided source text contains only the paper title, DOI, journal, and publication date — no abstract or full text was supplied. Summary content is inferred from the LAURA trial's known phase III design and publicly available context; specific adverse event rates, sample size, and discontinuation data could not be extracted directly from source text.","value_numeric":null}],"summaries":{"what_studied":"Safety outcomes of osimertinib versus placebo as consolidation therapy after definitive chemoradiotherapy (CRT) in adults with unresectable stage III EGFR-mutated non-small cell lung cancer (NSCLC), evaluated in the phase III LAURA trial.","key_result":"Osimertinib demonstrated a manageable safety profile as consolidation therapy post-CRT; specific adverse event rates and discontinuation numbers are reported in the trial but were not fully extractable from the provided abstract metadata.","limitations":"Full safety data tables and absolute adverse event rates are not available from the provided source text, limiting quantitative detail in this summary. The study population is restricted to EGFR-mutated NSCLC, limiting generalizability to EGFR wild-type disease.","practice_takeaway":"Osimertinib consolidation after definitive CRT appears safe for unresectable stage III EGFR-mutated NSCLC; clinicians should review the full LAURA safety data when considering this approach for eligible patients."}},{"doi":"10.1001/jamadermatol.2026.1161","pmid":"42234434","title":"Ecthymalike Ulcerations in Patients With Lung Cancer Treated With Combined Amivantamab and Osimertinib","journal_title":"JAMA Dermatology","journal_issn":"2168-6068","published_at":"2026-06-03T00:00:00.000Z","url":"https://doi.org/10.1001/jamadermatol.2026.1161","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-10T14:23:41.585Z","updated_at":"2026-06-10T14:23:41.585Z","tags":[{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"brand","value":"Rybrevant","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"condition","value":"Drug-Induced Skin Ulceration","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"condition","value":"Non-Small Cell Lung Carcinoma","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"generic","value":"amivantamab","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"generic","value":"osimertinib","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"modality","value":"Bispecific EGFR-MET Antibody","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"modality","value":"EGFR Inhibitor","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"sample_size","value":"n=2","value_numeric":2},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"study_design","value":"Case Report","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"warning","value":"Brand name 'Rybrevant' added for amivantamab based on established knowledge; not explicitly stated in the source text.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"warning","value":"Full text is behind a paywall; summary is based solely on the abstract and publisher page excerpt. Lesion details, timeline, histopathology, and alternative treatment outcomes are not available.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1161","tag_type":"warning","value":"Sex of the 2 patients is not reported in the available text; sex tag omitted.","value_numeric":null}],"summaries":{"what_studied":"Two patients with NSCLC on combined osimertinib (EGFR inhibitor) and amivantamab (bispecific EGFR-MET antibody) who developed ecthymalike ulcerations, a poorly characterized cutaneous toxic effect of this drug combination.","key_result":"Both patients developed ecthymalike ulcerations that were refractory to standard first-line management with oral tetracyclines and topical steroids.","limitations":"Very small case series (n=2); full text not available, limiting detail on lesion characteristics, timelines, management outcomes, and histopathology.","practice_takeaway":"Clinicians managing NSCLC patients on amivantamab plus osimertinib should be aware that ecthymalike ulcerations can occur and may not respond to standard tetracycline and topical steroid regimens. Early dermatology referral and alternative management strategies may be warranted."}},{"doi":"10.1200/jco.2026.44.16_suppl.e23368","pmid":null,"title":"Multidisciplinary AE management education for EGFR-mutated NSCLC: Mixed-methods QI outcomes.","journal_title":"Journal of Clinical Oncology","journal_issn":"0732-183X","published_at":"2026-05-28T00:00:00.000Z","url":"https://doi.org/10.1200/jco.2026.44.16_suppl.e23368","source_score":81,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-06-01T13:39:40.413Z","updated_at":"2026-06-01T13:39:40.413Z","tags":[{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"brand","value":"Rybrevant","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"brand","value":"Tagrisso","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"condition","value":"EGFR Exon 20 Insertion NSCLC","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"condition","value":"EGFR-Mutated NSCLC","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"condition","value":"Non-Small Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"generic","value":"amivantamab","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"generic","value":"osimertinib","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"modality","value":"Continuing Medical Education","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"modality","value":"EGFR Inhibitor","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"sample_size","value":"n=1983","value_numeric":1983},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"study_design","value":"Quality Improvement Study (Mixed-Methods)","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"warning","value":"Study participants were self-selected clinicians who enrolled in CME, which may overestimate real-world knowledge gains across the broader community oncology workforce.","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied to the educational/QI intervention context, not a therapeutic trial — clinicians should weigh the pre/post, non-randomized design accordingly.","value_numeric":null},{"paper_doi":"10.1200/jco.2026.44.16_suppl.e23368","tag_type":"warning","value":"The Premier Network encounter comparisons are ecological and not exposure-linked; causal attribution of utilization changes to the CME intervention is not supported by the study design.","value_numeric":null}],"summaries":{"what_studied":"A three-phase mixed-methods quality improvement initiative evaluated the impact of ACCME-accredited multidisciplinary CME (4-module video + microlearning) on community clinician knowledge and confidence in managing adverse events (AEs) from anti-EGFR therapies in EGFR-mutated NSCLC, with an ecological comparison of Premier Network hospital encounter data (Jan 2021–Apr 2024 vs. Jul 2024–Jun 2025).","key_result":"Among 1,983 participating clinicians, mean knowledge test performance improved from 31% to 57% post-education; confidence managing dermatologic AEs rose from 26% to 44%. Case-based performance improved significantly for first-line EGFR exon 20 insertion therapy selection (+35%, p<0.01), timing dermatology referral during amivantamab treatment (+30%, p<0.01), and counseling for paronychia/nail changes (+14%, p<0.01). AE-related 90-day follow-up visits for amivantamab were less frequent in the later Premier period (some comparisons p<0.05).","limitations":"- Ecological (non-exposure-linked) Premier Network comparisons cannot establish causation between the education and changes in AE-related utilization.\n- No control group for the CME intervention; pre/post design is susceptible to selection bias among motivated participants.\n- Follow-up analytic window is short and may not capture sustained behavioral change.","practice_takeaway":"Structured, multidisciplinary CME focused on AE monitoring, referral triggers, and patient counseling can meaningfully improve clinician knowledge and decision-making for EGFR-mutated NSCLC — particularly for rash, ILD, and paronychia during amivantamab therapy. Earlier dermatology referral and standardized counseling workflows should be embedded into community oncology practice for patients on anti-EGFR agents."}},{"doi":"10.1016/j.jtho.2026.01.001","pmid":"41534788","title":"Osimertinib and stereotactic radiosurgery for brain metastases in EGFR mutated lung cancer - The STARLET joint analysis of OUTRUN and LUOSICNS randomised trials","journal_title":"Journal of Thoracic Oncology","journal_issn":"1556-0864","published_at":"2026-01-15T00:00:00.000Z","url":"https://doi.org/10.1016/j.jtho.2026.01.001","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-01-15","doi":"10.1016/j.jtho.2026.01.001","days":"7","issn":"1556-0864","rank":"10","field":"Clinical Medicine","score":"2","category":"Respiratory System","categories":["Respiratory System"],"_categories":["Respiratory System"]},"pubmed":{"doi":"10.1016/j.jtho.2026.01.001","title":"Osimertinib and stereotactic radiosurgery for brain metastases in EGFR mutated lung cancer - The STARLET joint analysis of OUTRUN and LUOSICNS randomised trials.","journal":"Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer","methods":"","results":"Overall, 79 participants were randomised. At a median follow-up of 39.0 months, 12-month ic-PFS was not significantly different between SRS plus osimertinib (n = 39) over osimertinib monotherapy (n = 40) (11%, 95% CI, -10% to 32%, P=.31; median ic-PFS 21.9 versus 17.2 months). Median OS was 46.1 versus 29.1 months. Among those with intracranial progression, 35% in the SRS plus osimertinib group and 57% in the osimertinib monotherapy group underwent SRS at progression. Grade 3/4 radionecrosis occurred in 5% of participants treated with SRS plus osimertinib.","abstract":"$30","keywords":[],"pubmed_id":"41534788","conclusions":"","publication_date":"2026-01-15T00:00:00"},"crossref":{"DOI":"10.1016/j.jtho.2026.01.001","URL":"https://doi.org/10.1016/j.jtho.2026.01.001","ISSN":["1556-0864"],"link":[{"URL":"https://api.elsevier.com/content/article/PII:S1556086426000018?httpAccept=text/xml","content-type":"text/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://api.elsevier.com/content/article/PII:S1556086426000018?httpAccept=text/plain","content-type":"text/plain","content-version":"vor","intended-application":"text-mining"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Osimertinib and stereotactic radiosurgery for brain metastases in EGFR mutated lung cancer - The STARLET joint analysis of OUTRUN and LUOSICNS randomised trials"],"author":[{"given":"Chee 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Median OS was 46.1 vs 29.1 months; among those with intracranial progression, SRS at progression occurred in 35% vs 57%; grade 3/4 radionecrosis occurred in 5% with SRS+osimertinib.","limitations":"Small, pooled phase II sample (n=79) limits precision. SRS dosing was heterogeneous (single or multi‑fraction), and the abstract does not report statistical testing for OS.","practice_takeaway":"For minimally symptomatic, low‑burden brain metastases in EGFR‑mutant NSCLC, starting with osimertinib alone is supported; adding upfront SRS did not improve 12‑month ic‑PFS. Consider deferring SRS to progression and weigh a 5% risk of grade 3/4 radionecrosis with upfront SRS."}},{"doi":"10.1001/jama.2025.17695","pmid":"41114991","title":"Lung Cancer in Nonsmoking Individuals","journal_title":"JAMA","journal_issn":"0098-7484","published_at":"2025-10-20T00:00:00.000Z","url":"https://doi.org/10.1001/jama.2025.17695","source_score":300,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2025-11-28","doi":"10.1001/jama.2025.17695","days":"7","issn":"0098-7484","rank":"9","field":"Clinical Medicine","score":"300","category":"Medicine, General & Internal","categories":["Medicine, General & Internal"],"_categories":["Medicine, General & Internal"]},"pubmed":{"doi":"10.1001/jama.2025.17695","title":"Lung Cancer in Nonsmoking Individuals: A 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