Medical Oncology

Non-small cell lung cancer   

Questions discussed in this category


Given data presented at ASCO 2020? https://meetinglibrary.asco.org/record/191929/abstract

How do you prescribe a steroid taper? If it is grade 2, would you keep them on low dose prednisone while continuing? When do you feel comfortable re-c...

Are there specific mutations or co-mutations were you would consider use of this agent? 

Do the results of the unplanned subset analysis of the PACIFIC trial showing no OS benefit in this population lean you away from consolidation?

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 ...

In patients who have a mixed response or progression and are poor candidates for other systemic agents, would you consider consolidating the chest? Wo...

Are the other options of chemotherapy that can be used instead of platinum based doublets, including with paclitaxel? 

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

Do you recommend or make any modifications in the PACIFIC regimen for patients > 75 years of age?

Would you reserve TKI for after standard of care chemotherapy and immunotherapy or consider earlier line of treatment?

In clinical practice, consolidation chemotherapy is sometimes used, though this was not implemented in the PACIFIC trial. https://www.ncbi.nlm.nih.go...

Rate of pneumonitis was low in the PACIFIC trial but does it mirror the real world setting? We are seeing increased pneumonitis in our practice.

Do you feel it is important to start durvalumab within 14 days of completing cCRT?  What real life challenges do you face in doing so and wh...

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?

The EGFR subgroup appeared not have benefited as much as other patients in the publication. However, recently it was reported that the PACIFIC study m...

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 ...

If there is no other evidence of metastatic disease, would you offer thoracic radiation? Either upfront with chemo or after initial system therapy if ...

Carbo/pemetrexed/pembrolizumab, carbo/pemtrexed without immunotherapy or second line immunotherapy (Nivo, Pem or atezolizumab)?

The ALTA and ALEX trials showed better PFS with brigatinib v. crizotinib and alectinib v. crizotinib. How do you choose your first...

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

For example, would a + vascular margin, extranodal extension of N1 disease, translobar disease, or high risk histologies (large cell neuroendocrine, s...

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

I recently saw a patient who had been treated with concurrent pembrolizumab-RT elsewhere. Is this an acceptable practice outside the setting of a clin...

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

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?


Papers discussed in this category


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

Medical and pediatric oncology, 1990

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

N Engl J Med, 2017 Nov 16

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

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

The Lancet. Oncology, 2016-11

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

J. Clin. Oncol.,

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

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

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

Radiat Oncol, 2015 Apr 26

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-12-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-09-01

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

The Lancet. Oncology, 2017-07

International journal of radiation oncology, biology, physics, 2017-06-01

JAMA oncology, 2018-01-11

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

The Lancet. Respiratory medicine, 2017-11

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

Lung Cancer,

Lancet Oncol., 2008 Jun 24

JAMA oncology, 2017-05-01

J. Clin. Oncol., 2015 Nov 02

International journal of radiation oncology, biology, physics, 2015-09-01

Future Oncol, 2019 Apr 25

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

Clin. Cancer Res., 2018 Oct 08

International journal of radiation oncology, biology, physics, 2018-03-15

J Thorac Oncol, 2019 Feb 16

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-11-01

The New England journal of medicine, 2011-08-04

Lancet Oncol., 2012 May 22

J. Clin. Oncol., 2019 Dec 11

Lancet Oncol., 2017 Sep 25

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-12-01