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How would you manage a patient with surgically resected T3N1 NSCLC who is found to have one small brain metastasis on staging MRI?
In addition to addresing the brain met (surgery vs. SBRT), would you proceed with systemic "adjuvant" chemotherapy, or would you treat the patient as stage IV (PD-L1 testing, consideration of PD-1 inhibitor if >50%, etc)?
Answer from: Medical Oncologist at Academic Institution
For adjuvant chemotherapy, this is a difficult question for which there is no evidence-based answer, really. The "textbook" answer is that this is metastatic disease, and adjuvant therapy has only been proven for early stage disease. However, since there is still a reasonable chance of a cure ...
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Answer from: Medical Oncologist at Academic Institution
Concur with David. Pt is now NED, but at very high risk of recurrence elsewhere...
......Corey Langer
Answer from: Medical Oncologist at Academic Institution
Agree as well - would typically offer these patients 4 cycles of an appropriate cisplatin doublet as adjuvant therapy.
Of relevance regarding adjuvant use of immunotherapy is ANVIL, the recent extension of the ALCHMEIST trial, which will assess nivolumab x 1 year vs observation...