Non-small cell lung cancer&nbsp;&nbsp;&nbsp;

For NSCLC patients treated with neoadjuvant chemoimmunotherapy and surgery with ypN2 disease, what factors would cause you to recommend PORT?

In oligometastatic NSCLC with a solitary brain metastasis and lung primary amenable to SBRT, how would you sequence first-line systemic therapy versus local therapy to the lung after treatment of the CNS metastasis?

How would you treat a patient with newly diagnosed ALK+ Stage IIIB non-small cell lung cancer (NSCLC)?

Would you recommend concurrent chemoradiation or targeted therapy with lorlatinib?

How do you approach a patient with stage IIA non-small cell lung cancer who received SBRT?

Would you offer chemotherapy after radiation is completed?

Do you still offer adjuvant chemotherapy and chemoradiation for NSCLC after neoadjuvant chemoimmunotherapy?

NCCN states that all operable NSCLC patients should be evaluated for pre-op therapy with strong consideration of nivolumab + chemotherapy for those wi...

How do you treat Stage IIIC T4N3 NSCLC?

Some consider T4N3 Stage IIIC to be a borderline case. None of these patients were included in either PACIFIC or KEYNOTE-024 for example. Would y...

Do you have different hotspot and heterogeneity goals for SBRT of ground glass lesions vs more solid adenocarcinoma NSCLC lesions?

E.g. higher central hotspot in solid lesions? Any data on differences in toxicity?

How would you approach local therapy (surgery or RT) in a patient with radiographic complete response after chemoimmunotherapy for non-small-cell lung cancer?

Would you consider omitting local therapy?

Which patients with Stage II-III lung adenocarcinoma, in whom you are considering neoadjuvant chemoimmunotherapy, can you rely on liquid NGS to exclude driver mutations in lieu of repeat tissue biopsy?

Per NCCN exclusion of EGFR/ALK alterations at a minimum is recommended prior to consideration of neoadjuvant chemoimmunotherapy.

How are you approaching patients who receive neoadjuvant chemo immunotherapy for resectable NSCLC who after completion of neoadjuvant treatment are no longer surgical candidates due to factors such as toxicity, decline in PS, or patient preference?

What is the preferred second line, systemic therapy for NSCLC patients following first line chemoimmunotherapy?

How does the changing landscape of first-line treatment impact your decision making for second line therapy?

10 Answers available

How does the presence of interstitial lung disease affect your decision to offer SBRT for early stage NSCLC?

Specifically in O2-dependent patients? Have any dose/fractionation regimens been shown to reduce the risk of pneumonitis in this population?

What is your preferred approach for managing oligoprogressive NSCLC during second-line or later systemic therapy if patient is otherwise responding well at other sites of disease?

How do you counsel patients with Stage IIIA EGFR+ lung cancer regarding treatment intent with concurrent chemoRT + consolidative systemic therapy?

With low #s of patients on the durvalumab PACIFIC trial with EGFR mutated disease, and LAURA trial design of osimertinib until progression, should we ...

Is there increased risk with lung SBRT in a patient who has a mild asymptomatic pneumothorax in the field after CT-guided needle biopsy?

Would you offer adjuvant pembrolizumab to a stage II-III adenocarcinoma of the lung who had a complete pathologic response to 4 cycles of cisplatin/pemetrexed/pembro (KN-671)?

And would your answer be different if you had used pre-op nivolumab (CM-816)?

Do you offer local consolidative therapy for patients with polymetastatic driver mutation-positive NSCLC who respond well to targeted therapy?

If so, when and to what extent?

Would you consider omission of PORT for node+ NSCLC with a positive margin in the setting of a high tumor PD-L1 score and plans for immunotherapy?

Did NRG LU004 demonstrate safety with hypofractionated lung radiation and concurrent ICI?

Can you explain the expansion cohorts into larger trials and the current amendments to the the protocol?

Are you offering durvalumab to patients with Stage III NSCLC with known targeted mutations (ie ALK, EGFR, ROS1, BRAF) after completion of chemoradiation per PACIFIC?

Do you consider NSCLC with multistation N2 involvement appropriate for treatment with neoadjuvant chemoimmunotherapy followed by surgery?

In what situations would immunotherapy alone be appropriate for non-metastatic NSCLC?

In patients with EGFR mutant L858R stage III NSCLC who are unresectable due to multistation N2 disease, would you consider upfront osimertinib over definitive intent CCRT?

If CCRT is pursued, would you move forward with durvalumab consolidation? Assume the patient with ECOG PS 0 and no co-morbidities. How might this chan...

How many days do you hold osimertinib during or around SBRT for oligometastatic EGFR mutated advanced lung cancer?

Does the site of treatment factor into your decision?

Which patients with primary, early-stage NSCLC would you utilize immunotherapy in conjunction with SBRT?

This post refers to the recently published RCT by Chang et al., PMID 37478883 investigating lung SBRT with vs. without 4 months of nivolumab for early...

How would you approach Grade 2-3 rash due to erlotinib for a patient with metastatic EGFR mutated lung adenocarcinoma that is well controlled for > 5 years and NED by PET?

How are you approaching patients with early-stage NSCLC who progress on neoadjuvant chemo-immunotherapy and are no longer surgical candidates?

Will you consider definitive concurrent chemoradiation for stage IV lung adenocarcinoma with metastasis limited to an internal mammary lymph node?

When contouring locally advanced NSCLC, how do you define your ITV if your iGTV overlaps with an OAR?

E.g. esophagus? If you crop the esophagus out of the ITV, then your ITV would not fully encompass the iGTV.

What is your approach to adjuvant therapy for an R0, ALK+ resected lung adenocarcinoma with N2 disease?

How would you manage a left sided triple negative breast cancer with a concurrent left sided locally advanced non-small cell lung cancer?

The left breast cancer is an ER-negative, PR-negative, HER2-negative cT2N0 invasive ductal carcinoma, while the left lung primary is a cT2N1 squamous ...

How would you treat an endobronchial NSCLC abutting a hiatal hernia in a patient who is medically inoperable?

When planning concurrent chemoradiation for locally advanced NSCLC, do you consider prescribing primary tumor disease to a lower isodose line, such as 75%, if OAR constraints for standard prescribing are met?

Would you offer definitive CRT for stage III(N3) NSCLC treated with neoadjuvant immunotherapy who had a complete radiographic response?

If so, what dose of radiation dose would you use?

Would you offer a different ALK inhibitor to a patient receiving alectinib who had decompensation of liver function in the setting of preexisting cirrhosis?

Is there ever a role for adjuvant chemotherapy and/or immunotherapy for early stage, N0 non-small cell lung cancer treated with SBRT alone?

Do you prefer cisplatin or carboplatin in combination with nivolumab per CheckMate 816 for patients with resectable NSCLC?

Based on subgroup analysis, do you have a preference for cisplatin over carboplatin?

Would you consider using sotorasib first line in patient with metastatic KRAS G12C NSCLC who declines chemotherapy?

What are your top takeaways in Thoracic Cancers from ASCO 2023?

Which targeted therapies should we be more cautious of giving after recent immunotherapy in NSCLC?

Do you ever consider bridging with chemotherapy, and if so for how long?

When would you include treatment of the entire staple line for an NSCLC staple line recurrence?

Would you consider treating with conventional fractionation to the entire staple line with a boost to the gross disease?

How do you decide between checkpoint monotherapy versus chemo-immunotherapy approach for patients with PD-L1 High (>50%) NSCLC?

IMPower110 data add further support to use of checkpoint monotherapy; however guidelines continue to support either I/O monotherapy vs chemo-immunothe...

7 Answers available

What is your preferred first line approach to patients with Stage IV non-squamous NSCLC with good performance status, no driver mutations, PD-L1 low-positive, and CKD IIIB or worse, CrCl < 45 mL/min?

Assuming the patient had no contraindications to immunotherapy and no other significant comorbidities.

How do you define an adequate EBUS when staging NSCLC?

Is there a minimum standard for which stations to sample? Does lymph node size affect your recommendations?

Are you treating patients with RET-fusion+ metastatic NSCLC with RET inhibitors as the first line of therapy regardless of PD-L1 expression?

Are there scenarios in which you would proceed with checkpoint inhibitor for PDL1+ disease before having full molecular testing results?

What dose constraints do you use for 60 Gy in 15-20 fraction lung treatments that are adjacent to the hilum?

For NSCLC patients with limited diagnostic tissue that is insufficient for genetic testing, do you offer repeat biopsy (of accessible site), blood based testing, or both to evaluate for actionable driver mutations?

What is the role for "liquid biopsy" for patients with newly diagnosed metastatic NSCLC?

What dose constraint do you use for the proximal bronchial tree for when treating NSCLC to 60 Gy/8 fx?

I see the LungTECH trial dose constraints, but, they seem really conservative when you have something large and close the PBT resulting in use of 60 G...

Do you consider using 160 mg osimertinib in patients with EGFR-positive metastatic NSCLC to the brain?

How would you treat a potentially resectable stage III lung adenocarcinoma with an EGFR mutation?

Do you consider any neoadjuvant therapy or proceed to surgery followed by adjuvant chemotherapy and osimertinib? Does the type of mutation (ex a rare ...

What is your current practice for obtaining PD-L1 and mutation testing for newly diagnosed metastatic NSCLC?

What specific platforms do you use, individual biomarker/PD-L1 status vs NGS, tissue vs liquid or both? Must you wait for PD-L1 testing if mutation t...

Are PD-L1 and molecular markers from pleural fluid specimens reliable enough to guide decision making in metastatic NSCLC?

Or would you conduct tissue or blood testing if no actionable results are found?

Would you send a lung cancer patient for genetic counseling/germline mutation testing if they are harboring mutations in NGS with variation allele frequency between >=50%?

Ex. TP53, BRCA, T790M, or another? As of now, T790M mutation is one of the few de novo mutations found in treatment naïve patients that have been...

Do you ever start immunotherapy along with WBRT in patients with PDL1 >50% metastatic NSCLC with significant visceral tumor burden in addition to symptomatic brain mets?

How do you approach a patient with discordant mutation testing in liquid vs tissue biopsy for mNSCLC?

For patients with NSCLC on osimertinib who progress, would you continue osimertinib when moving onto chemotherapy for 2nd line therapy?

Based on results from ADAURA, in clinical practice, how likely are you to recommend adjuvant chemotherapy prior to adjuvant osimertinib for stage IIA T2bN0 EGFR mutant NSCLC?

How do you decide which immunotherapy agent to utilize for 1st line in PD-L1 high (>50%) NSCLC?

Are there specific clinical factors, efficacy, or treatment tolerability issues that lead you to favor one agent over another? How do you compare or ...

8 Answers available

Do you see any role for PARP inhibitors in NSCLC given the recent PIN trial of maintenance olaparib did not show significant improvement in PFS?

Based on results of the recently published study.

How do you modify your dose constraints when giving lung SBRT to a new lesion in a patient previously treated with lung SBRT?

How does your approach change for same lung but now a different lobe v. different lung? How do you adjust your constraints?

What is your approach and preferred first line treatment regimen for advanced/metastatic adenosquamous NSCLC?

Do you ever consider small vessel doses when determining your dose for SBRT?

For example, would you modify your SBRT dose next to the azygous vein? While we talk frequently about OAR constraints for the great vessels, it seems ...

What adjuvant therapy would you offer following adjuvant chemotherapy for a patient with Stage III lung adenocarcinoma with an atypical EGFR mutation such as EGFR L861R?

Would you offer adjuvant atezolizumab, osimertinib, or neither? Both IMpower010 and ADAURA only had patients with EGFR exon 19 deletion or L858R mutat...

Should durvalumab consolidation still be offered to Stage III NSCLC patients with PD-L1< 1%?

Do the results of the unplanned subset analysis of the PACIFIC trial showing no OS benefit in this population lean you away from consolidation?

Do you do recommend further mediastinal staging for patients with SCLC or inoperable NSCLC with N1 disease on PET?

If a patient clearly has N1 disease with high SUV on PET, do you routinely recommend EBUS or mediastinoscopy to evaluate for N2 disease?

Should IMPower010 results be extrapolated to superior sulcus tumors treated with chemoradiation and surgery?

For patients with KRAS G12C mutated NSCLC, how would you decide between using targeted therapy with sotorasib vs adagrasib?

Is there anything to differentiate the two agents? CNS penetration reportedly with adagrasib, FDA accelerated approval has been given with sotorasib.&...

How do you choose between neoadjuvant chemotherapy alone vs neoadjuvant chemoradiation in patients with potentially resectable stage III NSCLC who are not upfront surgical candidates?

Do you hold or avoid pemetrexed in patients with NSCLC and pleural effusions?

Would you ever consider definitive thoracic RT with concurrent immunotherapy in Stage III NSCLC?

I recently saw a patient who had been treated with concurrent pembrolizumab-RT elsewhere. Is this an acceptable practice outside the setting of a clin...

How do you manage a patient with metastatic NSCLC whose initial mutation testing was limited or results are no longer available?

How do you operationalize finding biomarker information in EHRs/testing portals, either for your own patients or if they have changed providers? If a...

What are your treatment considerations for a patient with stage IVb NSCLC who is KRAS G12C mutated and PD-L1 high (>50%)?

Are there best practices for managing or mitigating toxicity from sotorasib such as hyperbilirubinemia or edema?

Do you offer durvalumab to patients with stage IIIB NSCLC after chemoradiation if they are also on long term dialysis for ESRD?

Are there data for using checkpoint inhibitors in this setting?

Which patients with resectable Stage IB-IIIA NSCLC would most benefit from using neoadjuvant chemoimmunotherapy as per CheckMate 816?

What are best practices for engaging with multidisciplinary colleagues to ensure patients with earlier stage NSCLC are being appropriately considered for novel adjuvant therapies?

How are your teams effectively evaluating and counseling patients to ensure they are prepared for potential extended adjuvant treatment approaches? Is...

Would you extrapolate IMPower010 data to offer adjuvant atezolizumab to a patient with N2 PDL1-high (>50%) NSCLC who had been treated with induction chemotherapy followed by definitive R0 resection after partial response?

Can atezo be used even if patient has completed chemotherapy preoperatively?

What is your preferred first line treatment approach for a patient with PDL-1 high (>50%) NSCLC presenting with CNS mets?

If a patient is asymptomatic at presentation, how do you incorporate local treatment options (RT/surgery) and when?

What high risk features for stage IB NSCLC would lead you to consider adjuvant chemotherapy?

Do you consider size > 2cm, visceral pleural invasion or vascular invasion as indications for cisplatin-based chemotherapy?

Would you hold osimertinib in a patient with a STEMI, and for how long?

Are there any data for second line nivolumab-ipilimumab in patients with metastatic NSCLC treated with either single agent pembrolizumab or chemotherapy + ICI as first line therapy?

Would you consider second line nivo-ipi for patients with a specific histology or tumor PD-L1 expression?

How would use of adjuvant atezolizumab for PDL1+ NSCLC potentially impact your treatment choice at recurrence?

Is there a certain time interval where you would feel comfortable to rechallenge with immunotherapy at recurrence (6m vs 1y vs 2y?) Does degree of PDL...

Should 1 year of atezolizumab be the standard of care for stage II-IIIA resected PDL1+ NSCLC?

Are the experts convinced by DFS when the OS is immature? How many in BSC arm went on to receive immunotherapy and was that adequate?

What is your recommended adjuvant approach to resected NSCLC with both PD-L1>1% and EGFR mutation?

What would you do for a patient with a non-EGFR actionable mutation?IMpower010 included EGFR and ALK mutated NSCLC. Is there any concern in the use of...

How do you approach patients with Stage IIIB/C NSCLC with ipsilateral supraclavicular (N3) disease?

Do you initially start with systemic therapy alone or do you proceed directly to chemo-radiation?

Are there clinical features that would lead you to consider combining SBRT + immunotherapy in a high risk early stage NSCLC?

Are you selecting any specific patient cohort with metastatic NSCLC for treatment with the CheckMate 9LA protocol of ipilimumab + nivolumab + 2 cycles of chemotherapy?

What is your preferred first line regimen for PDL1-negative squamous cell lung cancer?

What is your general rationale for selecting from available options?

What factors do you take into account for recommending chemo/IO vs IO/IO vs CheckMate 9LA regimen in front line therapy for PD-L1 negative advanced squamous cell carcinoma?

How do you interpret the comparative efficacy in squamous cell subsets among the CM vs KN vs EMPOWER studies?

Do you avoid immunotherapy in patients with Stage IV NSCLC with atypical EGFR mutations such as G719S or S768I?

How do you approach EGFR mutated NSCLC with isolated progression in the chest who is planned for a course of radiation at least 3-4 weeks?

How do you balance the risk of an EGFR flare while holding osimertinib vs the risk of pneumonitis when continuing?

How would you treat a patient with stage 4 NSCLC with EGFR R776H mutation?

Do you have a maximum size cutoff for lung SBRT in central NSCLC?

E.g. for a 7cm central NSCLC, would you offer 8 fx SBRT or ChemoRT? Patient is not a surgical candidate.

What would you offer as adjuvant therapy for a resected stage IIIB adeno NSCLC in a patient who refuses chemotherapy?

Can adjuvant durvalumab or other I/O or osimertinib (if EGFR+) be considered?

How do you approach patients with driver mutation positive, Stage IV NSCLC who don't benefit from upfront first-line TKI?

Although a small subset, do you generally move these patients directly on to chemotherapy +/- immunotherapy or does it depend on the specific mutation...

Are there specific ROS1 fusions/mutations that confer sensitivity or resistance to therapy to help guide treatment selection in first line or at progression?

How would you treat a patient with squamous NSCLC with NRG1 amplification (no fusion) who has progressed on first-line treatment?

Would you consider afatinib? Afatinib has shown some activity in NRG1 fusion + patients but amplifications is unclear.

When giving single agent docetaxel for patients with metastatic NSCLC who have progressed on platinum and immunotherapy, do you stop after 6 cycles or do you continue as long as tolerated and disease is stable?

What is your approach to a patient with an EGFR exon 19 mutated NSCLC who develops progression on osimertinib and repeat biopsy demonstrates the EGFR exon 19 mutation and a new BRAF V600E mutation?

For a patient with metastatic NSCLC, PD-L1>50%, after progression on first line checkpoint inhibitor, do you prefer chemotherapy alone or chemotherapy added to the immunotherapy?

9 Answers available

What is your preferred first line therapy in metastatic ALK+ NSCLC?

The ALTA and ALEX trials showed better PFS with brigatinib v. crizotinib and alectinib v. crizotinib. How do you choose your first...

How do you approach treatment for patients with ALK+ mNSCLC who have multifocal or leptomeningeal CNS progression while on first-line targeted therapy?

Would you test for resistance mutations in this setting, using blood-based sample if no progression outside CNS?

How do you manage ALK-inhibitor AEs which are low grade but significantly impact patient QOL over time?

Such as dysgeusia, headache, rash, fatigue, etc

How can you adjust neoadjuvant or adjuvant platinum based chemotherapy for stage Stage II-III non-small cell lung cancer in patients with significant renal insufficiency?

In locally advanced EGFR-mutated NSCLC with initial good response to osimertinib, how do you manage local progression of the primary?

Would you consider SBRT and continue osimertinib?

How do you approach missed doses of durvalumab consolidation in patients with Stage III NSCLC?

Do you aim to give a total of 26 doses or do you stop at one year from first dose no matter how many were given?

Is there a preferred ALK targeting agent for patients with ALK+ mNSCLC presenting with CNS metastases?

Should 3 years of adjuvant osimertinib be the standard of care for resected Stage IB-IIIA EGFRm NSCLC?

For patients with early stage resected giant cell lung cancer and other less common histologies, are there any specific considerations for adjuvant therapy?

How do you approach patients with unresectable NSCLC planned for concurrent chemoradiation who develop a serious infusion reaction to paclitaxel?

Would you consider maintenance immunotherapy following chemoradiation for a patient with an isolated mediastinal recurrence of NSCLC?

How would you approach metastatic NSCLC (adenocarcinoma without brain mets) with PD-L1 >50% and BRAF V600E driver mutation?

How would you treat oligometastatic NSCLC (brain and bone) with Non-V600E BRAF mutations?

SRS done to the single brain met, PD-L1 5%, BRAF G469A mutation

How would you treat a patient with metastatic NSCLC with repeated episodes of CNS brain metastases but otherwise with good systemic disease control on maintenance therapy?

The patient remains without evidence of systemic disease outside of the CNS on serial imaging. Would you continue treating with SRS as lesions appear,...

Would you offer systemic therapy after rendered NED from SRS to isolated CNS metastases in a patient with prior curative intent treatment of lung adenocarcinoma and clear cell RCC?

0 Answers available

How do you manage pneumonitis in patients with Stage III NSCLC receiving durvalumab?

How do you prescribe a steroid taper? If it is grade 2, would you keep them on low dose prednisone while continuing? When do you feel comfortable re-c...

Are there any subsets of patients where you would consider first-line dacomitinib for EGFR mutations positive NSCLC?

Are there specific mutations or co-mutations were you would consider use of this agent?

Would you offer EGFR inhibitors to a patient with metastatic lung adenocarcinoma EGFR L858R mutation and concomitant NRAS mutation both on blood based testing?

In patients with metastatic lung SCC who are on pembrolizumab maintenance after starting pembrolizumab/carboplatin/nab-paclitaxel, what is your treatment strategy if they progress while on pembrolizumab alone?

Would you continue pembrolizumab with a re-challenge with carboplatin/taxane or move to second line therapy?

Should we consider deferring adjuvant chemotherapy for resected early-stage NSCLC in light of COVID-19?

If so, how long is too long to wait?

Would you discontinue dabrafenib/trametinib in a patient with BRAF mutant metastatic lung cancer if you see mild cardiomyopathy which could be related to the drugs?

Patient does not want chemo but is tolerating these well otherwise.

Should lung SBRT fractions be delivered on consecutive days, every other day, or perhaps an even more prolonged schedule?

Does tumor location play a role (central vs peripheral) in making the decision? The question stems from an oral presentation at ASTRO 2014 inves...

7 Answers available

How do you counsel patients with metastatic NSCLC who have a sustained response (> 2 years) to checkpoint inhibitors who wish to discontinue therapy?

How do you approach this given the limited # of patients this applies to? Checkmate 017 and 057 only had 5-7% of patients still on nivolumab at ...

Do patients with Stage III unresectable NSCLC with lepidic features require a different approach to chemo-radiation?

Would your choice of concurrent chemotherapy be impacted by this histologic finding?

0 Answers available

Do you offer consolidative thoracic radiation for oligometastatic NSCLC following upfront immunotherapy?

In patients who have a mixed response or progression and are poor candidates for other systemic agents, would you consider consolidating the chest? Wo...

Would you rather start radiation for Stage III NSCLC in the middle of a chemotherapy cycle or wait for the 2nd cycle if it could not be started on cycle 1 day 1?

How would you manage a patient with no driver mutation, PD-L1 <50%, with systemic relapse of lung adenocarcinoma within a year after resection and completion of adjuvant platinum based chemotherapy?

Would you consider single agent immunotherapy given recent exposure to platinum agent or chemoimmunotherapy?

How do you approach patients for definitive chemoradiation in locally advanced NSCLC who have severe neuropathy?

Are the other options of chemotherapy that can be used instead of platinum based doublets, including with paclitaxel?

How long do you continue surveillance imaging for NSCLC after definitive treatment?

NCCN recommends annual CT surveillance indefinitely after year 5, but I’m curious how many physicians continue and for how long?

How do you decide between carboplatin vs not recommending adjuvant chemotherapy entirely for patients with resected NSCLC with relative or absolute contraindications to cisplatin?

ie renal dysfunction, hearing loss, neuropathy

Would you deliver SRS/XRT for isolated asymptomatic CNS metastasis before start of immunotherapy for stage IV lung cancer (negative for driver mutation) with high positive PDL1?

Do you consider additional chemotherapy or durvalumab after definitive concurrent chemo/RT for Stage II NSCLC for patients who are not surgical candidates?

Would PDL-1 status impact your decision?

How do you approach elderly patients with stage III NSCLC who have a reasonable performance status?

Do you recommend or make any modifications in the PACIFIC regimen for patients > 75 years of age?

Aside from MET exon 14 skip mutations, are there other targetable MET mutations or fusions that you would consider for TKI therapy?

Would you reserve TKI for after standard of care chemotherapy and immunotherapy or consider earlier line of treatment?

Do you offer consolidation chemotherapy prior to durvalumab in locally advanced, unresectable NSCLC?

In clinical practice, consolidation chemotherapy is sometimes used, though this was not implemented in the PACIFIC trial.Antonia et al., PMID 28885881...

How do you monitor response for stage III NSCLC patients receiving consolidation immunotherapy?

CT or PET? If so, how often?

Does consolidation durvalumab increase the risk of pneumonitis in Stage III NSCLC?

Rate of pneumonitis was low in the PACIFIC trial but does it mirror the real world setting? We are seeing increased pneumonitis in our practice.

For patients with inoperable stage III NSCLC who are unable to receive or refuse definitive chemoradiation, how do you decide among radiation alone, pembrolizumab alone, or radiation followed by either pembrolizumab or durvalumab?

How do you time re-staging studies and adjuvant durvalumab for stage III NSCLC treated with definitive cCRT?

Do you feel it is important to start durvalumab within 14 days of completing cCRT? What real life challenges do you face in doing so and wh...

What are the clear criteria for unresectability in locally advanced NSCLC patients, other than medical or anatomic?

Medical inoperability is clearly defined, anatomical resectability is also pretty much clear (invasion of trachea/carina/esophagus, etc). But what abo...

Do you recommend adjustment of lung dose constraints in the setting of stage III lung cancer treated with definitive concurrent chemoradiation followed by planned consolidation immunotherapy?

Do you stop consolidative durvalumab after one year as per the PACIFIC trial or continue if the patient is otherwise tolerating well?

Would you offer the PACIFIC protocol to a patient with stage III lung cancer with performance status 2-3?

If so, how would you modify this regimen?

If you are treating a patient with palliative radiation for hemoptysis do you require chemotherapy to be held?

If you are using a standard 30/10 fractionation, is there a benefit to keeping chemo on board for radio-sensitization?

For stage III NSCLC treated with definitive intent chemoRT, how do you decide to proceed with surgery vs consolidation immunotherapy?

What would be your approach in a patient with MET amplification and PDL-1 80% expression?

Do you use crizotinib for first-line therapy?

How are you treating patients who progress while on durvalumab after definitive chemoradiation for stage III NSCLC?

Is the timing of progression (in relation to chemoradiation) a factor, and is there any role for repeat PD-L1 testing at the time of progression?

Do you consider MET amplification in your first-line treatment decisions for patients with metastatic NSCLC?

Do you ever consider a dose constraint to the spleen when treating lung tumors with stereotactic radiotherapy?

I am treating a left lower lobe NSCLC and my PTV is so close to the spleen that a small portion of the spleen is getting significant dose. I can...

How do you manage a patient who presents with a tracheoesophageal fistula from a lung or esophageal primary that is non-metastatic?

As a for instance, a centrally located primary tumor with mediastinal adenopathy that results in a TE fistula? Currently we would recommend esophagea...

When do you recommend broader molecular testing for clinical trials in stage IV NSCLC patients who have negative initial molecular testing for FDA-approved targetable mutations?

0 Answers available

Would you resume durvalumab after several month hiatus due to IO unrelated medical comorbidities that has since resolved?

If it is still within the 12 month period and no disease recurrence?

Would you deliver SBRT to the adrenal gland if a patient has already undergone contralateral adrenalectomy for oligometastatic NSCLC?

What would you anticipate with regard to potential adrenal toxicity when the patient has only 1 functioning adrenal gland? There are no other sites of...

Does EGFR+ status influence your decision? What is the significance of this finding and its potential for progression? Is it simply occult disease con...

How would you approach treatment in patients with stage III non small cell lung cancer invading the atrium of the heart?

Do you recommend elective mediastinal nodal irradiation for an inoperable NSCLC patient with N1 disease who is unable to undergo mediastinal staging?

Does the T stage or location of malignancy affect your decision?

How do you decide between enrolling an oligometastatic NSCLC patient on LU-002 versus treating them with SBRT off trial?

Since the randomized phase II data from Gomez et al presented at ASTRO 2018 showed a survival benefit, is there concern about randomizing patients to ...

How important is a severely diminished diffusion capacity in determining whether to offer a lung cancer patient radiotherapy?

Does it factor into your decision making in the setting of restricted spirometry and normal lung volumes? Does this differ for SBRT v. chemoRT?

Would you offer upfront osimertinib rather than whole brain irradiation for a patient with stage IV, EGFR exon 19 mutated lung adenocarcinoma who presents with leptomeningeal metastases?

Should radiotherapy be utilized in stage IVA NSCLC with a malignant pericardial effusion?

If there is no other evidence of metastatic disease, would you offer thoracic radiation? Either upfront with chemo or after initial system therapy if ...

Would you include any elective nodal stations for cases of T3/T4 node-negative NSCLC staged by PET/CT in which a patient cannot undergo nodal sampling?

Would your answer differ based on whether the patient is receiving concurrent chemotherapy? Are there other factors that would influence this decision...

For oligometastatic NSCLC that would be otherwise considered stage 3, would you consider consolidative immunotherapy with durvalumab after definitive treatment for both the primary and oligometastatic site?

When do you choose motion management over free-breathing techniques for lung SBRT?

Do you prefer breath-hold techniques (ABC, DIBH) or abdominal compression regardless of tumor motion? Or do you use a general threshold number of cc's...

What would you choose as the second line treatment option for a stage IV EGFR mutant lung adenocarcinoma that has progressed on osimertinib?

Carbo/pemetrexed/pembrolizumab, carbo/pemtrexed without immunotherapy or second line immunotherapy (Nivo, Pem or atezolizumab)?

What lung constraint do you use when delivering SBRT for local failure of early stage NSCLC following surgery?

Does this vary based on whether the patient had a lobectomy v. wedge resection?

What is the role of upfront pembrolizumab in metastatic PD-L1 positive NSCLC presenting with SVC syndrome?

Would starting with chemotherapy be preferred in this situation and consider concurrent radiation, then switch over to Pembrolizumab once some control...

Would you offer immunotherapy after chemoradiotherapy for Stage III lung cancer given results of PACIFIC Trial?

If so how would you select patients (ie. PS, histology, PD-L1 expression level)?

What potential risks of SBRT do you counsel patients on when treating early stage lung cancer with an underlying chronic lung infection?

In a patient with a cavitated lesion with underlying chronic infection (identified as cocci) and SqCC, are there additional risks to SBRT? Should spec...

How do you manage a stage I LLL medically inoperable lung cancer in close proximity to the stomach?

In patients with aberrant anatomy due to previous surgery with lung PTV overlapping the stomach, how much would you dose de-escalate? Even conventiona...

Do you use a chest wall constraint when treating large lung cancers with 8 or 10 fraction SBRT?

If so, what constraint is most clinically relevant? The EORTC LungTech trial (60Gy/8 fractions) does not specify a chest wall constraint. I have...

Do you ever recommend PORT or chemoRT rather than chemotherapy alone for NSCLC with adverse features other than positive margins or N2 disease?

For example, would a + vascular margin, extranodal extension of N1 disease, translobar disease, or high risk histologies (large cell neuroendocrine, s...

Is there concern for hemorrhage after SBRT to a lung metastasis that directly involves a branch of the pulmonary artery?

What dose and fractionation would you consider if surgery is not an option?

How do you counsel patients in regards to the options and risks for salvage lobectomy/wedge after SBRT?

Do you discuss this at the first consultation? Is there strong evidence to suggest that risks are significantly increased compared to upfront lobectom...

What is your preferred first line approach to patients with good PS stage IV non-squamous NSCLC that is EGFR/ROS1/ALK/BRAF WT and PDL-1 < 1%?

Do you prefer carboplatin-paclitaxel-bevacizumab, carboplatin-pemetrexed-pembrolizumab, or chemotherapy alone?

Is surgery preferable over SBRT for peripheral NSCLC invading into ribs?

Is local control worse for SBRT when the tumor is invading into the bone (rib)?

How would you approach treatment for a patient with locally advanced NSCLC and systemic scleroderma if chemoradiation is their only curative option?

What factors do you use to decide between phase based vs. amplitude based gating for lung SBRT?

How do you fractionate SBRT for NSCLC abutting the chest wall or in which the PTV encompasses part of the chest wall?

What is the role of "adjuvant" systemic chemotherapy in patients previously resected NSCLC, now with isolated solitary relapsed brain lesion, treated with resection and SBRT?

Is there any data for the benefit for systemic chemo in such situation?

Does proximity to or involvement of the aorta effect the dose and fractionation you use for an early stage NSCLC?

For example, a NSCLC of the LLL abutting and potentially involving the adventitia of the descending aorta?

How does your management of locally advanced NSCLC change in a patient with a previous contralateral pneumonectomy?

For a patient with a new contralateral primary or recurrence and previous pneumonectomy, what lung constraints do you prioritize (ex mean lung dose, V...

How do you decide on the sequence of systemic and local therapy for patients with oligometastatic NSCLC?

When would you favor delivering local therapy (e.g. SBRT) prior to systemic therapy?

When do you recommend induction chemotherapy prior to concurrent chemoradiotherapy for locally advanced NSCLC?

If you treat pre-chemotherapy volumes, is there a benefit to induction chemotherapy even in bulky disease. If so, how do you define disease that ...

Do you recommend concurrent or sequential radiation and chemotherapy for margin-positive, node negative NSCLC?

What factors influence your decision (R1 v. R2 resection? T stage?) If sequential, do you typically prefer radiation before or after chemotherapy?

Would you recommend a cycle of chemotherapy prior to concurrent chemoradiation for a Stage III NSCLC patient who needs to start treatment sooner than allowed by the IMRT planning process?

Or would you rather treat with 3D-CRT in order to initiate chemoRT concurrently?

How do you approach a peripheral, T1 lung cancer with a positive mediastinal node by EBUS?

Is there a role for SBRT to the primary site? Is it required to treat the ipsilateral hilum if no adenopathy was seen on EBUS or PET?

Do you use a TKI for resected EGFR+ non-small cell lung cancer?

In IB-IIIA cases?

What dose constraint, if any, do you use for the diaphragm when treating liver or lung tumors with SBRT?

Have you ever seen toxicity related to diaphragm dose with conventional fractionation?