In patients with RET-fusion positive NSCLC with symptomatic brain metastases, would you consider starting selpercatinib/pralsetinib upfront or would you proceed with whole brain radiation with TKI to follow?  

In general, my favored approach for a patient with asymptomatic brain metastasis (and nothing scary like big edema, midline shift, bleeding, etc) is brain-penetrating TKI, if available. This applies to EGFR (osi), ALK (alectinib), and RET (I use selpercatinib). Happily, these patients live longer. W...