Medical Oncology

Lung Cancer   

Questions discussed in this category


If yes, do you recommend it be given concurrently with chemotherapy or sequentially? What is your target volume and dose?

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 ...

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

1st-line pembrolizumab is supposed to be used AFTER failure of appropriate targeted agents in this setting, but would you consider the reverse sequenc...

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?

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 ...

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

This has become standard practice at our institution for patients with a good performance status, with whole brain radiotherapy given after the comple...

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

Can SRS or whole brain radiotherapy be reserved for progression in these young, healthy patients?

If so, what fields do you irradiate? The initially involved nodal regions? If not, do you consolidate at any point in the future (ie after a loca...

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

These patients have been largely excluded from these trials.  What if the infection is well controlled?

Do you increase dosage of the TKI or switch to a different generation TKI?  How does your answer differ for EGFR vs. ALK, and for discerete brain...

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?

Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...

Would it make a difference if the VTE diagnosis occurs during bevacizumab therapy or whether it preceded the cancer diagnosis?

Can T790M mutation develop within this early time frame, or are these perhaps patients who may benefit from switch to chemotherapy?

Or do you recommend treatment with systemic therapy alone, as this represents Stage IV disease?

Are you using ctDNA blood tests for targetable mutations at the time of diagnosis, at the time of disease progression, or not at all?

What is the best evidence for what dose to use? When would you give it in relation to the checkpoint inhibitors? Which metastatic sites do you choose ...

Some medical oncologists tend to hold anticoagulation in patients who develop brain metastases for fear of causing intracranial hemorrhage.  Is t...

How long do you typically wait before starting consolidation chemotherapy, and do you routinely perform re-staging scans prior to consolidation? 

What immunosuppressive agents are used and in what order?  Does your approach differ depending on the organ involved, e.g. colitis vs. pneumoniti...

In addition to addresing the brain met (surgery vs. SBRT), would you proceed with systemic "adjuvant" chemotherapy, or would you treat the patient as ...

 Is there any data to support this approach? If not, are there trials you are aware of looking at "rescuing" these patients with a different chec...

Does the extent/duration of systemic disease control (complete response vs. stable disease, for example) influence your decision?  What about whe...

Does the risk of severe inflammation of the liver lead you to choose other therapies in in this population?  What about in patients with mild liv...

If these are presumed to be immune-mediated (e.g. immune neutropenia or immune thrombocytopenia), do you treat with steroids?

The Phase III J-ALEX study and two phase II studies seem to suggest favorable intracranial response rates for alectinib. 

Since results of the phase III J-ALEX study were reported at ASCO 2016, do you try to obtain alectinib in the first-line setting instead of crizotinib...

Based on recently published data from CheckMate 032, do you now offer nivolumab to small cell patients who have progressed after first-line chemothera...

Does the type of autoimmune disease (ex IBD, rheumatoid arthritis, interstitial lung disease) matter?

4cm has historically been used as the cutpoint for determining benefit from adjuvant chemotherapy in this population (Strauss et al, JCO 2008; Bu...

Although PD-1 inhibitors are now standard of care for second-line therapy of advanced NSCLC, there remains the question of which therapy is best to us...

It seems like the RADIANT trial, finding an 18 month DFS benefit for adjuvant erlotinib, would favor this, but the study calls this "not statistically...

As it is suggested for larger tumors treated with surgery, based on post hoc CALGB analysis?

Based on the European data published in the Lancet (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961085-0/abstract), are you s...

For example, should nivolumab be considered standard second-line therapy for adenocarcinoma patients?   Can it be considered for first-line thera...

I am aware that chemotherapy can obviate the need for RT in patients with SVC syndrome, but I'm not sure if this can be extrapolated to spinal cord co...

Should mutations other then EGFR and ALK be routinely tested for? Should next generation sequencing be routinely done?

I've read about patients who were treated with concurrent bevacizumab-RT who developed lethal tracheoesophageal fistulas. How long would you have to w...


Papers discussed in this category


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Lancet, 2015 Jan 3

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

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

Lancet, 1998 Jul 25

Int. J. Radiat. Oncol. Biol. Phys., 1999-08-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-03-10

Radiat Oncol, 2015 May 27

International journal of radiation oncology, biology, physics, 2016-06-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-04-01

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

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

N. Engl. J. Med.,

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

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Lancet Oncol., 2014 May 13

The Lancet. Oncology, 2015-08

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-11-01

The Lancet. Oncology, 2016-07

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

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2013-07

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The Lancet. Oncology, 2015-07

Annals of oncology : official journal of the European Society for Medical Oncology, 2013-09

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Medicine (Baltimore),

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-10-01

Blood, 2015-07-23

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

Clin. Cancer Res., 2015-04-15

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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

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

N Engl J Med, 2017 Nov 16

Immunotherapy, 2016-10

J Thorac Oncol,

Clin. Cancer Res., 2015 May 27

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

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

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

The Lancet. Respiratory medicine, 2019-05

Ann. Oncol.,

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Nature, 2017-04-26

Cancer discovery, 2017-12

Cancer discovery, 2016-10

The Lancet. Oncology, 2016-11

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

J. Clin. Oncol.,

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

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

Lung Cancer,

Lancet Oncol., 2008 Jun 24

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

J. Clin. Oncol., 2015 Nov 02

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