Which treatment option addresses a PD-L1 positive and EGFR mutant lung cancer?

• A. Crizotinib
• B. Tamoxifen
• C. Erlotinib + Gefitinib (EGFR TK inhibitors), Keytruda
• D. Herceptin

Answer: (C)

When a lung cancer has an activating EGFR mutation, the tumor is often driven by EGFR signaling, and using an EGFR tyrosine kinase inhibitor is a targeted way to block that pathway. At the same time, PD-L1 positivity suggests potential responsiveness to immune checkpoint blockade with a PD-1/PD-L1 inhibitor. The option that directly addresses both features combines an EGFR TKI to target the mutation with pembrolizumab to address PD-L1 positivity, making it the approach that tackles both aspects of the disease.

Crizotinib targets ALK, ROS1, and MET alterations—not EGFR mutations. Tamoxifen is used for hormone receptor–positive breast cancer. Trastuzumab (Herceptin) targets HER2, which is not the driver in most lung cancers.