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Topics:
Radiation Oncology • Thoracic Malignancies • Medical Oncology • Non-small cell lung cancer • Stage III NSCLC • Targeted therapies
Under what circumstances, if any, would you wait on initiating a TKI for metastatic recurrence of a Stage III NSCLC which occurred while on consolidative durvalumab to minimize pneumonitis risk?
One particular circumstance involved detecting a ROS1 fusion upon the metastatic recurrence. Is this pneumonitis risk seen with osimertinib alone or would you also apply this to ALK inhibitors, ROS1 inhibitiors, or any other TKI classes?
Answer from: Medical Oncologist at Academic Institution
Hepatotoxicity is of greater concern with ALK/ROS1 inhibitors. ALK inhibitors such as crizotinib or alectinib in combination with anti-PD1/PD-L1 agents led to higher than expected rates of hepatic and/or dermatologic AEs (Spigel et al., PMID 29518553; Kim et al., PMID 35875467). The field has l...
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Answer from: Medical Oncologist at Academic Institution
I agree with the answer. In patients with significant disease burden of recurrence, one may start with systemic chemotherapy as a bridge to TKI. Otherwise, as stated, one may consider SRS for oligometastasis.