Non-small cell lung cancer   

Questions discussed in this category



Both ALK and MSI-high status were noted on a liquid biopsy since there was not enough tissue available for molecular testing. Some reports suggest lo...

One particular circumstance involved detecting a ROS1 fusion upon the metastatic recurrence.  Is this pneumonitis risk seen with osimertinib alon...

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

Would you recommend concurrent chemoradiation or targeted therapy with lorlatinib?

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

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...

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

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

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

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...

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...

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

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 ...

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

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

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

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

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

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...

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...

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

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

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 ...

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

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

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

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

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

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

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

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

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...

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 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...

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

What is your general rationale for selecting from available options?

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

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

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

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

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

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

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?

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

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

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

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 ...

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

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

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

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

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

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

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.

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...

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

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

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?

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...

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

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...

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 ...

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

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

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...

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

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

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

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

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

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

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

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

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

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

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

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

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 ...

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

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?

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


Papers discussed in this category


Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-10-20

Cancer, 1998 Mar 15

International journal of radiation oncology, biology, physics, 2012-11-01

JAMA, 2010-03-17

International journal of radiation oncology, biology, physics, 2017-03-15

International journal of radiation oncology, biology, physics, 2015-11-15

Radiother Oncol, 2013 Aug

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2016-10

International journal of radiation oncology, biology, physics, 2016-12-01

Practical radiation oncology, 2018

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2005-09-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2007-05-01

Medical and pediatric oncology, 1990

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1986-01

N Engl J Med, 2017 Nov 16

The New England journal of medicine, 2015-10-22

Lancet (London, England), 2017-01-21

The Lancet. Oncology, 2016-11

The New England journal of medicine, 2018-05-31

International journal of radiation oncology, biology, physics, 2009-04-01

J. Clin. Oncol.,

The New England journal of medicine, 2016-11-10

The New England journal of medicine, 2017-06-22

Clinical lung cancer, 2016-11

International journal of radiation oncology, biology, physics, 2006-07-01

International journal of radiation oncology, biology, physics, 2007-10-01

The New England journal of medicine, 2018-12-13

Pulmonary medicine, 2012

Radiat Oncol, 2015 Apr 26

Clin Lung Cancer, 2017 Jul 10

J Thorac Oncol,

Clinical lung cancer, 2018-07

Int. J. Radiat. Oncol. Biol. Phys., 2017 Mar 15

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2016-06

Journal of vascular and interventional radiology : JVIR, 2021 Mar 31

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-12-10

Lancet (London, England), 2014-08-23

The New England journal of medicine, 2018-06-14

Lancet Oncol, 2019 May 20

J Clin Oncol, 2022 Jun 03

Frontiers in immunology, 2023 Dec 11

International journal of radiation oncology, biology, physics, 2007-02-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-09-01

International journal of radiation oncology, biology, physics, 2012-05-01

International journal of radiation oncology, biology, physics, 2012-02-01

International journal of radiation oncology, biology, physics, 2010-03-01

Journal of radiosurgery and SBRT, 2011

The New England journal of medicine, 2018-11-22

The Lancet. Oncology, 2017-07

International journal of radiation oncology, biology, physics, 2017-06-01

JAMA oncology, 2018-01-11

J Thorac Oncol, 2018 Feb

The New England journal of medicine, 2017-08-31

Ann Oncol, 2020 May 11

N Engl J Med,

J Clin Oncol, 2020 Aug 11

J Thorac Oncol,

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2015-08

Clinical lung cancer, 2015-11

Am. J. Clin. Oncol., 2007-06-01

Medicine (Baltimore),

Eur Radiol, 2016 Mar 04

Medical physics, 2011-11

The Lancet. Respiratory medicine, 2017-11

Clin Lung Cancer, 2017 Mar

Lancet (London, England), 2009-08-01

Lung Cancer,

Lancet Oncol., 2008 Jun 24

Clin Lung Cancer, 2018 Apr 18

Int. J. Radiat. Oncol. Biol. Phys., 2010-06-01

Thorac Cancer, 2017 Apr 24

International journal of radiation oncology, biology, physics, 2013-03-01

Respir. Res., 2018 Apr 24

International journal of radiation oncology, biology, physics, 2011-10-01

International journal of radiation oncology, biology, physics, 2012-06-01

JAMA oncology, 2017-05-01

Int. J. Radiat. Oncol. Biol. Phys., 2008 Jan 30

Thorac Surg Clin,

International journal of radiation oncology, biology, physics, 2013-04-01

International journal of radiation oncology, biology, physics, 2014-04-01

J Natl Cancer Inst, 2014 Aug

Practical radiation oncology, 2016

International journal of radiation oncology, biology, physics, 2015-09-01

J Thorac Oncol, 2016-07-01

N. Engl. J. Med.,

PLoS ONE, 2015 Nov 24

J. Clin. Oncol., 2015 Nov 02

JAMA oncology, 2019-07-01

Future Oncol, 2019 Apr 25

J Clin Oncol, 2023 Jan 31

Lancet (London, England), 2023 Jul 18

Lancet (London, England), 2023 Jul 18

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-11-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2010-01-01

Lancet (London, England), 2016-04-09

Clin. Cancer Res., 2018 Oct 08

International journal of radiation oncology, biology, physics, 2018-03-15

J Thorac Oncol, 2019 Feb 16

The New England journal of medicine, 2011-08-04

The Journal of molecular diagnostics : JMD, 2018-03

Ann Oncol, 2020 Feb 06

Acta Cytol, 2021 Jul 07

Lancet Oncol., 2012 May 22

J. Clin. Oncol., 2019 Dec 11

Lancet Oncol., 2017 Sep 25

The New England journal of medicine, 2014-11-13

Lancet Oncol., 2017 Sep 11

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-03-10

N Engl J Med, 2020 Sep 19

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-12-01

J Clin Oncol, 2020 Dec 04

J Thorac Dis,

Ann. Oncol., 2015 Apr 28

J Clin Oncol, 2020 Sep 10

Lung cancer (Amsterdam, Netherlands), 2017-10

Curr Oncol, 2020 May 01

Mol Cancer, 2020 Sep 11

PLoS One, 2018 Aug 28

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-11-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-11-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-03-20

JCO precision oncology, 2019

Annals of oncology : official journal of the European Society for Medical Oncology, 2019-08-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-05-01

Annals of oncology : official journal of the European Society for Medical Oncology, 2016-07

Clin Lung Cancer, 2020 Feb 10

JTO Clin Res Rep, 2020 May 13

Clin Oncol (R Coll Radiol), 2017 Nov 16

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2014-06

Radiother Oncol, 2020 Jul 31

The New England journal of medicine, 2018-11-22

Lancet, 2017 Jan 24

The Lancet. Oncology, 2014-09

Cancer Sci,

The Lancet. Oncology, 2015-07

The Lancet. Respiratory medicine, 2019-05

N. Engl. J. Med., 2019 Sep 28

ESMO Open, 2021 Oct 01

J Clin Oncol, 2021 Apr 19

Lancet Oncol, 2021 Jan 18

N Engl J Med,

Lancet,

Ann. Oncol.,

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2018-08

J Thorac Oncol, 2021 Jul 08

Lancet (London, England), 2019-05-04

J Clin Oncol, 2021 Jan 29

J BUON,

Br J Cancer, 2019 Sep 30

The New England journal of medicine, 2005-06-23

Lancet Oncol., 2006-09-01

J. Clin. Oncol., 2008-07-20

The Lancet. Oncology, 2017-12

N. Engl. J. Med.,

International journal of radiation oncology, biology, physics, 2015-06-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-05-20

Chest, 2003-11

The Lancet. Oncology, 2017-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-04-20

JAMA Oncol,

Clin Lung Cancer, 2021 Jan 27

Eur J Cancer, 2021 Apr 01

Lancet Oncol, 2019 Oct 25

Biochemistry, 2015 Jul 06

N Engl J Med, 2019 Nov 21

Lancet Oncol, 2016 Apr 12

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2013-01

Future Oncol, 2018 Nov 08

World J Clin Cases,

Br J Cancer, 2016 Nov 22

Clinical cancer research : an official journal of the American Association for Cancer Research, 2011-10-01

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2015-01

Lung Cancer, 2020 Nov 13

Neuropathology, 2019 Mar 13

Respir Investig, 2014 Nov 13

Lancet, 2021 Sep 20

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2018-04

J Thorac Oncol, 2021 May 05

JACC CardioOncol, 2019 Dec 17

N Engl J Med, 2022 Apr 11

Clin Cancer Res, 2010 May 11

Cancer Chemother Pharmacol, 2014 Jun 17

N Engl J Med, 2022 Jun 03

Oncology, 2020 May 28

Ann Oncol, 2022 Feb 14

FEBS J, 2009 Nov 18

Clin Lung Cancer, 2018 May 01

J Thorac Oncol, 2021 Feb 01

N Engl J Med, 2021 Jun 04

Radiation oncology (London, England), 2015-02-18

EClinicalMedicine, 2022 Aug 11

The Lancet. Oncology, 2015-02

Eur Respir J, 2005 Aug

N Engl J Med, 2023 Jun 28

The New England journal of medicine, 2018 Apr 16

The Lancet. Oncology, 2020 May 07

Translational lung cancer research, 2019 Sep

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2009 Aug 21

Cancers, 2021 Sep 26

Clinical lung cancer, 2023 Jul 25

ERJ open research, 2020 Feb 17

Clinical Medicine Insights. Oncology, 2023 Feb 14

J Clin Oncol, 2019 Dec 06

Ann Oncol, 2020 Jul 05

J Thorac Oncol, 2021 Aug 19

Clin Transl Sci, 2023 Feb 19

J Clin Oncol, 2011 Nov 28

J Clin Oncol, 2019 Jun 13

J Clin Oncol, 2022 Aug 12

J Thorac Oncol, 2023 Feb 23

Future Oncol, 2021 Jul 19

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-06-20

BMC Cancer, 2019 Aug 19

The New England journal of medicine, 2023 Jun 04

Chest, 2016-03

Chest, 2008 Feb 08

JAMA, 2010 Nov 24

J Oncol Pharm Pract, 2018 Jun 05

The New England journal of medicine, 2013-04-04

Ann Oncol, 2020 Jan 24

Br J Cancer, 2020 Oct 05

Transl Lung Cancer Res, 2022 Jul

JAMA Oncol, 2018 Aug 01

J Thorac Oncol, 2018 Mar 06

Journal of clinical pharmacology, 2018-12

Investigational new drugs, 2023 Apr 13

Case reports in oncology, 2021 Mar 01

Journal of the National Cancer Institute, 2023 Jun 08

J Thorac Oncol, 2021 Apr 03

JAMA Oncol,

The New England journal of medicine, 2023 Jun 03

N. Engl. J. Med.,

The New England journal of medicine, 2024 May 16

Cancer journal (Sudbury, Mass.), 2020 Nov/Dec

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2021 Feb 12

Journal for immunotherapy of cancer, 2021 Aug

International journal of cancer, 2019 Feb 19

The Lancet. Respiratory medicine, 2023 May 05

Lancet (London, England), 2023 Dec 14

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2019-01

The American journal of surgical pathology, 2020 Sep

The oncologist, 2024 Feb 21

Molecular cancer research : MCR, 2009 Sep 08

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2022 Apr 22

The Annals of thoracic surgery, 2015-02

Lancet (London, England), 2010 Mar 24

The New England journal of medicine, 2024 Jun 02

The New England journal of medicine, 2018-01-11

International journal of radiation oncology, biology, physics, 2024 Feb 20

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2012-04-20

Nature medicine, 2023 Nov 13

Journal of neurosurgery, 1998-06

Pract Radiat Oncol, 2020 Oct 31

J Immunother Cancer, 2020 Oct

J Immunother Cancer, 2019 Sep 4

Front Cardiovasc Med, 2023

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2016 Sep 03

Journal of immunology (Baltimore, Md. : 1950), 2005 Jun 15

International journal of radiation oncology, biology, physics, 2020 May 15

International journal of radiation oncology, biology, physics, 2022 Nov 24

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2023 Feb 03

Frontiers in oncology, 2023 Sep 06

Signal transduction and targeted therapy, 2021 Nov 22

International journal of radiation oncology, biology, physics, 2024 Apr 12

The New England journal of medicine, 2023 Oct 23

The Lancet. Respiratory medicine, 2024 Mar 12

The Lancet. Oncology, 2022 Sep 12

Front Oncol, 2023

The New England journal of medicine, 2024 Apr 11

Lancet Oncol, 2021 Dec 15

JTO clinical and research reports, 2022 Jun 25