{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T09:46:36Z","timestamp":1785923196589,"version":"3.56.0"},"reference-count":63,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008207","name":"AstraZeneca","doi-asserted-by":"publisher","award":["91224315"],"award-info":[{"award-number":["91224315"]}],"id":[{"id":"10.13039\/100008207","id-type":"DOI","asserted-by":"publisher"}]},{"award":["91224315"],"award-info":[{"award-number":["91224315"]}],"id":[{"id":"https:\/\/ror.org\/04n8fbz89","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Curr. Oncol.","Current Oncology"],"abstract":"<jats:p>The management of epidermal growth factor receptor-mutated (EGFRm) non-small cell lung cancer (NSCLC) after progression on osimertinib is becoming increasingly complex, particularly in Canada, where access to diagnostic testing and newer therapies remains uneven. Although treatment is evolving with regimens such as amivantamab\u2212lazertinib (MARIPOSA\/MARIPOSA-2) and osimertinib plus chemotherapy (FLAURA2), access to such treatments in first and second lines varies across provinces. This article provides a pragmatic Canadian perspective on post-osimertinib management informed by expert roundtable discussions, a focused clinician survey, and the contemporary literature. Key challenges identified include delays and barriers related to tissue biopsy, next-generation sequencing, timely immunohistochemistry in time to influence treatment decisions and access to novel therapies. These gaps reduce the ability to individualize care and often force clinicians to rely on platinum-pemetrexed therapy as the default systemic backbone, even when biologically relevant resistance mechanisms exist, highlighting that post-osimertinib care in Canada remains shaped as much by access and system constraints as by emerging evidence.<\/jats:p>","DOI":"10.3390\/curroncol33080465","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T08:14:46Z","timestamp":1785917686000},"page":"465","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pragmatic Management of EGFR-Mutant NSCLC After Progression on Osimertinib: Canadian Expert Perspectives"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1464-2235","authenticated-orcid":false,"given":"Nathalie","family":"Daaboul","sequence":"first","affiliation":[{"name":"Centre Int\u00e9gr\u00e9 de Canc\u00e9rologie de la Mont\u00e9r\u00e9gie, H\u00f4pital Charles-Le Moyne, Greenfield Park, QC J4V 2H1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason S.","family":"Agulnik","sequence":"additional","affiliation":[{"name":"Jewish General Hospital, McGill University, Montr\u00e9al, QC H3A 0G4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houda","family":"Bahig","sequence":"additional","affiliation":[{"name":"Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al (CHUM), Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, QC H3T 1J4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2698-4362","authenticated-orcid":false,"given":"Normand","family":"Blais","sequence":"additional","affiliation":[{"name":"Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al (CHUM), Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, QC H3T 1J4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-\u00c8ve","family":"Boucher","sequence":"additional","affiliation":[{"name":"H\u00f4tel-Dieu de L\u00e9vis, L\u00e9vis, QC G6V 3Z1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5222-6904","authenticated-orcid":false,"given":"Nicole","family":"Bouchard","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire de Sherbrooke, Universit\u00e9 de Sherbrooke, Sherbrooke, QC J1N 3C6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-H\u00e9l\u00e8ne","family":"Denault","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec\u2013Universit\u00e9 Laval (IUCPQ-ULaval), Qu\u00e9bec City, QC G1V 4G5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrice","family":"Desmeules","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec\u2013Universit\u00e9 Laval (IUCPQ-ULaval), Qu\u00e9bec City, QC G1V 4G5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre Olivier","family":"Fiset","sequence":"additional","affiliation":[{"name":"McGill University Health Centre, McGill University, Montr\u00e9al, QC H3A 0G4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Florescu","sequence":"additional","affiliation":[{"name":"Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al (CHUM), Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, QC H3T 1J4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Jao","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology and Hematology, H\u00f4pital du Sacr\u00e9-Coeur de Montr\u00e9al, Montreal, QC H4J 1C5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5675-8214","authenticated-orcid":false,"given":"Catherine","family":"Labb\u00e9","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec\u2013Universit\u00e9 Laval (IUCPQ-ULaval), Qu\u00e9bec City, QC G1V 4G5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magali","family":"Lecavalier-Barsoum","sequence":"additional","affiliation":[{"name":"Jewish General Hospital, McGill University, Montr\u00e9al, QC H3A 0G4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmela","family":"Pepe","sequence":"additional","affiliation":[{"name":"Jewish General Hospital, McGill University, Montr\u00e9al, QC H3A 0G4, 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