For patients with advanced NSCLC who have radiographic disease progression on their follow-up scan after starting a PD-1 inhibitor, what characteristics (either clinical or radiographic) do you use to determine whether to continue with therapy or switch to something else?

I ask this question recognizing there is no great data here, and that "pseudo-progression" is rare, but I am looking for any guidance with regard to how you approach this decision (it comes up a lot!)

Answer from: Medical Oncologist at Academic Institution

I agree with @Edward B. Garon - there are two situations in which I would consider continuing therapy for another 4 or 6 weeks, 1) if as he has noted, there is some inconsistency (ie some areas worse and some better) AND the patient is feeling well, 2) if there is modest radiographic progressio...

Answer from: Medical Oncologist at Academic Institution

True pseudoprogression is very rare in non-small cell lung cancer. There are instances in which the scan results are inconsistent (e.g. some areas improved and some worsened), and I think that in such cases, it is reasonable to individualize treatment decisions. If scans at or after 8 weeks are clea...

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For patients with advanced NSCLC who have radiographic disease progression on their follow-up scan after starting a PD-1 inhibitor, what characteristics (either clinical or radiographic) do you use to determine whether to continue with therapy or switch to something else?

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