Lung Cancer&nbsp;&nbsp;&nbsp;

How would you manage a patient with stage IV EGFR L858R mutation but with a debilitating drug rash from osimertinib?

Should we switch to a new TKI?

In patients with EGFR mutant L858R stage III NSCLC who are unresectable due to multistation N2 disease, would you consider upfront osimertinib over definitive intent CCRT?

If CCRT is pursued, would you move forward with durvalumab consolidation? Assume the patient with ECOG PS 0 and no co-morbidities. How might this chan...

How many days do you hold osimertinib during or around SBRT for oligometastatic EGFR mutated advanced lung cancer?

Does the site of treatment factor into your decision?

Do you use immune checkpoint inhibitors in NSCLC patients with pre-existing, well-controlled autoimmune disease?

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

How are you approaching patients with early-stage NSCLC who progress on neoadjuvant chemo-immunotherapy and are no longer surgical candidates?

Will you consider definitive concurrent chemoradiation for stage IV lung adenocarcinoma with metastasis limited to an internal mammary lymph node?

What is your approach for an RA patient with lung cancer who is starting immunotherapy?

Is dyspnea without radiation pneumonitis a side effect of lung radiation?

Is this acute or long-term, and does it matter whether this is SBRT vs fractionated?

For a patient with a lung tumor that is radiographically consistent with early-stage NSCLC but pathology with characteristics overlapping with upper GI origin, what additional diagnostic procedures would you consider before treating?

For example, there are no abnormalities on CT or PET in the upper GI and the pathology demonstrates strong CK7 staining and mucinous features with neg...

How would you manage a left sided triple negative breast cancer with a concurrent left sided locally advanced non-small cell lung cancer?

The left breast cancer is an ER-negative, PR-negative, HER2-negative cT2N0 invasive ductal carcinoma, while the left lung primary is a cT2N1 squamous ...

Is it acceptable to treat newly diagnosed small cell lung cancer with limited brain metastasis with upfront SRS?

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

12 Answers available

Would you offer a different ALK inhibitor to a patient receiving alectinib who had decompensation of liver function in the setting of preexisting cirrhosis?

In a patient with history of successfully treated locally advanced H&N cancer, how do you discern between a metachronous second primary locally advanced lung SCC vs. metastatic head and neck SCC?

What clinical or radiographic factors would lean you in either direction - ie. time since index diagnosis, distribution or appearance of lung and noda...

How would you treat active rheumatoid arthritis in a patient in complete response on loralatinib for stage IV ALK positive NSCLC?

Patient already on methotrexate and plaquenil.

Is there any role for re-biopsy and NGS for patients with NSCLC and KRAS G12C at time of progression after first line therapy before starting sotorasib, or after progression on sotorasib?

Would you ever consider repeating chemoradiation for patients with locally recurrent small cell lung cancer after prior chemoradiation for LS-SCLC?

What are your top takeaways in Thoracic Cancers from ASCO 2023?

How do you schedule IV/PO Dexamethasone if giving immunotherapy concurrently with chemotherapy in patients with NSCLC?

Would you offer adjuvant immunotherapy to patients with stage II-III NSCLC who achieved a pathologic complete response from 3 cycles of neoadjuvant nivolumab + chemotherapy?

How do you define an adequate EBUS when staging NSCLC?

Is there a minimum standard for which stations to sample? Does lymph node size affect your recommendations?

Are there any data regarding safety or efficacy of osimertinib and concurrent chemotherapy in patients with metastatic NSCLC harboring sensitizing EGFR mutation?

For NSCLC patients with limited diagnostic tissue that is insufficient for genetic testing, do you offer repeat biopsy (of accessible site), blood based testing, or both to evaluate for actionable driver mutations?

What is the role for "liquid biopsy" for patients with newly diagnosed metastatic NSCLC?

What is your current practice for obtaining PD-L1 and mutation testing for newly diagnosed metastatic NSCLC?

What specific platforms do you use, individual biomarker/PD-L1 status vs NGS, tissue vs liquid or both? Must you wait for PD-L1 testing if mutation t...

Are PD-L1 and molecular markers from pleural fluid specimens reliable enough to guide decision making in metastatic NSCLC?

Or would you conduct tissue or blood testing if no actionable results are found?

Would you send a lung cancer patient for genetic counseling/germline mutation testing if they are harboring mutations in NGS with variation allele frequency between >=50%?

Ex. TP53, BRCA, T790M, or another? As of now, T790M mutation is one of the few de novo mutations found in treatment naïve patients that have been...

How do you manage stage III resectable NSCLC patients treated with neoadjuvant chemoimmunotherapy per CheckMate 816 with residual disease who subsequently refuse surgery?

Would you recommend standard definitive chemoradiation followed by adjuvant durvalumab? Would you treat pre- or post-systemic therapy volumes?

Do you consider the duration of lung/lobar atelectasis in your decision making while offering airway stents for malignant central airway obstruction?

Are patients with long standing malignant central airway obstruction poor candidates for central airway stents? What is considered to be an acceptable...

How do you approach a patient with discordant mutation testing in liquid vs tissue biopsy for mNSCLC?

What is the appropriate management of severe myalgia during atezolizumab infusion?

When treating patients with immune checkpoint inhibitors, do you routinely check markers of endocrinopathies such as TSH/ACTH, or only when a patient has symptoms?

If so, how often do you check these labs?

How do you choose between neoadjuvant and adjuvant chemo-immunotherapy for patients with resectable stage II-IIIA NSCLC?

In light of CheckMate 816 and IMpower010 and FDA approval for neoadjuvant chemo-nivolumab and adjuvant chemo-atezolizumab, how do you decide which sys...

How would you approach adjuvant therapy for a patient with pT2N2 lung adenocarcinoma who underwent an R1 resection and is not amenable to further surgical intervention?

NGS without any actionable mutations and PD-L1 TPS 15%. Would you offer chemotherapy, radiation, or immunotherapy and, if so, in what order?

For patients with NSCLC on osimertinib who progress, would you continue osimertinib when moving onto chemotherapy for 2nd line therapy?

Would you still offer adjuvant osimertinib to patients who elect not to receive chemotherapy in resected EGFR mutated lung cancer?

Do you incorporate immunotherapy in your multi-modality treatment after chemoradiation for patients with potentially resectable stage III superior sulcus NSCLC?

What do you view as the role for docetaxel+ramucirumab for patients with metastatic NSCLC in light of LUNG-MAP S1800a data?

Would you still use ram/doce in 3rd or later lines after ram/pembro?

Are there differences in efficacy of ramucirumab + pembrolizumab based on extent and duration of response to first line chemo/pembro?

Did S1800a stratify by prior treatment response? Would you choose different 2L treatment for a patient who progresses rapidlly on pembro + platinum do...

Are there any unique toxicity concerns with combination of ramucirumab/pembrolizumab as compared with other available treatments for metastatic NSCLC?

How do you counsel patients on the available second line options?

Are there any situations where you would consider neoadjuvant chemoradiation as opposed to chemoimmunotherapy for patients with resectable NSCLC prior to surgical resection?

How do you choose between neoadjuvant chemotherapy alone vs neoadjuvant chemoradiation in patients with potentially resectable stage III NSCLC who are not upfront surgical candidates?

In a life-time non-smoker with stage IV lung adenocarcinoma presenting in visceral crisis, what therapy would you recommend to avoid organ failure while awaiting mutational status?

What are your top takeaways in Thoracic Cancers from ASCO 2022?

What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?

What is the optimal treatment strategy for patients with stage IV NSCLC who have an actionable molecular target identified after initiation of first-line systemic therapy?

What systemic therapy, if any, would you offer a patient after WBRT for an isolated CNS relapse of initially limited stage SCLC that received chemoRT without PCI?

Would the timing of the relapse (eg within 6 months) impact your decision making?

How would you approach treatment of a patient with metastatic NSCLC with PD-L1>1% and HER2-mutation?

Does this change for PDL1 1-49% vs >50%? Will you be more likely to employ other checkpoint inhibitors before use of HER2 targeting therapy? Or sta...

For a patient with metastatic NSCLC who had progression x2 at a single site treated w RT, would you switch systemic treatment?

Patient has been on pembrolizumab and had two symptomatic soft tissue mass treated with radiation.

Do you perform PDL1 and molecular testing for patients with stages I-III NSCLC?

How do you interpret efficacy of trastuzumab deruxtecan based on HER2 mutation type and/or level of HER2 overexpression?

How and when do you plan to perform HER2 testing in patients with NSCLC?

Do you find data from phase 2 DESTINY-LUNG01 study sufficient to change practice in HER2 mutant NSCLC or is a phase 3 study still needed?

How does trastuzumab deruxtecan compare to other HER2 targeted strategies?

How would you approach a patient with mediastinal-only recurrence of small cell lung cancer < 6 months after primary surgical resection and adjuvant platinum-etoposide for Stage I disease?

What is your approach to a patient with metastatic lung cancer with HER2 mutant NSCLC who is not a trial candidate?

How are you thinking about sequencing therapies for these patients (IO vs chemo vs T-Dxd)? Are the data from DESTINY-Lung01 strong enough to warrant e...

What strategies can be employed to manage interstitial lung disease seen with trastuzumab deruxtecan?

Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use? Do you feel the dosing used in...

Do you recommend postoperative radiation therapy for pathologic T1-2N1 small cell carcinoma of the lung?

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

Does concurrent brain and systemic progression alter your choice of systemic therapy for patients with metastatic SCLC with early progression on chemoimmunotherapy and WBRT?

Would you offer topotecan, lurbinectedin, or another agent given the CNS progression as well?

Is it reasonable to offer observation with MRI rather than immediate PCI for patients with limited stage SCLC?

7 Answers available

How do you incorporate PCI into your management of patients with extensive stage SCLC?

Given that prophylactic cranial irradiation (PCI) has been shown to decrease the incidence of symptomatic brain metastases in patients with extensive ...

How do you evaluate a suspicious, but negative pleural effusion when working up NSCLC and SCLC?

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

What is your preferred first line therapy for ROS1 rearranged metastatic NSCLC without CNS mets?

How do you decide between entrectinib or crizotinib? Since no head-to-head comparison, can real world datasets (such as Doebele et al) be used to comp...

Can immunotherapy, alone or with chemo, be considered for ROS1+ NSCLC after exhausting ROS1 targeted therapy options?

Would you use a hippocampal sparing technique when treating with PCI for a limited stage small cell lung cancer?

How would you treat a patient with squamous NSCLC with NRG1 amplification (no fusion) who has progressed on first-line treatment?

Would you consider afatinib? Afatinib has shown some activity in NRG1 fusion + patients but amplifications is unclear.

As consolidative thoracic radiation (cTRT) was prohibited on the seminal chemoimmunotherapy trials in ES-SCLC, how do you approach cTRT in practice?

Would you consider it for a patient who had bulky thoracic disease, with limited extrathoracic disease at diagnosis and achieved a CR after induction ...

Is there a preferred ALK targeting agent for patients with ALK+ mNSCLC presenting with CNS metastases?

Should we consider radiation therapy for patients with N2 EGFRm NSCLC who will receive osimertinib, though RT was excluded on ADAURA?

Conversely: In a patient with N2 EGFR+ NSCLC receiving radiation, would you still consider use of osimertinib?

How do you treat a patient with widely metastatic, non T790M mutated, EGFR exon 20 insertion mutated lung cancer?

Are there any data to support a specific TKI therapy for non-T790M exon 20 mutations/insertions?

How does the lack of mandated PET or brain MRI in the ADAURA trial impact your interpretation of the results?

Is data available regarding the percentages of patients in each arm who underwent staging PET or the breakdown of CNS imaging modalities?

How will the ADAURA study impact your use of adjuvant chemotherapy?

Are the rates of adjuvant chemotherapy used in ADAURA consistent with real-world practice?

Would you give immunotherapy to patient with metastatic NSCLC who had liver transplant for hepatocellular carcinoma and now is progressing on chemotherapy?

How would you treat oligometastatic NSCLC (brain and bone) with Non-V600E BRAF mutations?

SRS done to the single brain met, PD-L1 5%, BRAF G469A mutation

How would you treat a patient with metastatic NSCLC with repeated episodes of CNS brain metastases but otherwise with good systemic disease control on maintenance therapy?

The patient remains without evidence of systemic disease outside of the CNS on serial imaging. Would you continue treating with SRS as lesions appear,...

Do you use bevacizumab in patients with history of VTE (DVT/PE) who are stable on anticoagulation?

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

Would you offer systemic therapy after rendered NED from SRS to isolated CNS metastases in a patient with prior curative intent treatment of lung adenocarcinoma and clear cell RCC?

In patients with metastatic lung SCC who are on pembrolizumab maintenance after starting pembrolizumab/carboplatin/nab-paclitaxel, what is your treatment strategy if they progress while on pembrolizumab alone?

Would you continue pembrolizumab with a re-challenge with carboplatin/taxane or move to second line therapy?

How do you counsel patients with metastatic NSCLC who have a sustained response (> 2 years) to checkpoint inhibitors who wish to discontinue therapy?

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 ...

Would you rather start radiation for Stage III NSCLC in the middle of a chemotherapy cycle or wait for the 2nd cycle if it could not be started on cycle 1 day 1?

How long do you continue surveillance imaging for NSCLC after definitive treatment?

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

How would you treat a patient with metastatic NSCLC >50% PDL-1 positive AND an EGFR or ALK gene mutation/rearrangement in the first-line setting?

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

Would you deliver SRS/XRT for isolated asymptomatic CNS metastasis before start of immunotherapy for stage IV lung cancer (negative for driver mutation) with high positive PDL1?

Do you consider additional chemotherapy or durvalumab after definitive concurrent chemo/RT for Stage II NSCLC for patients who are not surgical candidates?

Would PDL-1 status impact your decision?

For patients with metastatic NSCLC with MET amplification who respond well to first line crizotinib but develop hepatotoxicity, how do you decided whether to consider re-challenge or change therapy altogether?

What are the clear criteria for unresectability in locally advanced NSCLC patients, other than medical or anatomic?

Medical inoperability is clearly defined, anatomical resectability is also pretty much clear (invasion of trachea/carina/esophagus, etc). But what abo...

If you are treating a patient with palliative radiation for hemoptysis do you require chemotherapy to be held?

If you are using a standard 30/10 fractionation, is there a benefit to keeping chemo on board for radio-sensitization?

How are you treating patients who progress while on durvalumab after definitive chemoradiation for stage III NSCLC?

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?

Do you offer consolidation thoracic radiation after atezolizumab, carboplatin, and etoposide for extensive stage small cell lung cancer?

When do you recommend broader molecular testing for clinical trials in stage IV NSCLC patients who have negative initial molecular testing for FDA-approved targetable mutations?

Would you resume durvalumab after several month hiatus due to IO unrelated medical comorbidities that has since resolved?

If it is still within the 12 month period and no disease recurrence?

How do you decide between enrolling an oligometastatic NSCLC patient on LU-002 versus treating them with SBRT off trial?

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 ...

What is the role of upfront pembrolizumab in metastatic PD-L1 positive NSCLC presenting with SVC syndrome?

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

What is your preferred first line approach to patients with good PS stage IV non-squamous NSCLC that is EGFR/ROS1/ALK/BRAF WT and PDL-1 < 1%?

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

Is it acceptable to treat patients with limited, asymptomatic brain metastases and EGFR-mutant NSCLC with upfront TKI?

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

8 Answers available

How do you decide on the sequence of systemic and local therapy for patients with oligometastatic NSCLC?

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

Would you treat a patient with HIV or hepatitis C with an anti-PD-1 agent?

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

Aside from radiation (WBRT or SRS), what is your approach to patients with EGFR-mutated or ALK-translocated metastatic NSCLC who have systemic disease control but fail in the CNS?

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...

When do you recommend induction chemotherapy prior to concurrent chemoradiotherapy for locally advanced NSCLC?

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 ...

Do you recommend concurrent or sequential radiation and chemotherapy for margin-positive, node negative NSCLC?

What factors influence your decision (R1 v. R2 resection? T stage?) If sequential, do you typically prefer radiation before or after chemotherapy?

How would you approach patients with EGFR mutation positive (exon 19) NSCLC who rapidly progress on front line EGFR inhibition with first generation TKI at first imaging?

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

Should NSCLC with positive cervical nodes be managed with definitive chemoradiation?

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

Is there a role in sending liquid biopsy for patients progressing on ALK inhibitors?

How are you using liquid biopsy in the routine management of your patients with metastatic NSCLC?

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

Can ctDNA be used to evaluate response to checkpoint inhibitors in NSCLC when pseudoprogression is suspected on CT imaging?

Is there any role for ctDNA testing after surgery or SBRT for Stage IB NSCLC to determine the need for adjuvant chemotherapy?

How are you incorporating abscopal radiation into your practice for metastatic NSCLC?

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 ...

How do you manage anticoagulation for patients with DVT/PE who have brain metastases?

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

When do you offer consolidation chemotherapy for patients receiving chemoradiation for locally advanced NSCLC?

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

Do you offer memantine for patients undergoing PCI?

How do you manage immune-related toxicity from checkpoint inhibitors that is refractory to initial steroid therapy?

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

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 ...

In patients with metastatic NSCLC, would you consider atezolizumab after failure of nivolumab or pembrolizumab?

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...

Would you continue immune checkpoint inhibitor therapy in a metastatic NSCLC patient with CNS failure if the systemic disease is otherwise controlled?

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

Would you use immune checkpoint inhibitors in patients with well-compensated liver cirrhosis?

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...

How do you manage hematologic toxicities in solid tumor patients treated with immune checkpoint inhibitors?

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

When do you consider using ALK targeted systemic therapy in lieu of WBRT or SRS for patients with metastatic ALK-positive NSCLC?

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

Do you use anti-PD-1/anti-PD-L1 therapies in lung cancer patients with a prior history of radiation pneumonitis?

What about patients who are still on steroids for radiation pneumonitis?

For lung cancer patients who experience grade 3/4 toxicity from a PD-1 inhibitor necessitating cessation of therapy, but whose tumor has responded to the treatment, do you consider restarting PD-1 inhibitor therapy at the time when they progress again?

Would you consider giving the therapy with concominant steroids, or with a dose reduction?

For the first-line treatment of metastatic lung adenocarcinoma without a targetable driver mutation, do you routinely add bevacizumab to the chemotherapy backbone in the absence of a contraindication to the drug?

Do you add bevacizumab regardless of whether you are using paclitaxel or pemetrexed with the platinum agent?

Are there any subgroups of patients with advanced/metastatic NSCLC for whom you are using PD-1 inhibitors in the first-line setting, either alone or in combination with platinum-based chemotherapy?

Also, are you testing for PD-L1 routinely prior to initiation of first-line systemic therapy?

Do you offer the addition of necitumumab to first-line chemotherapy for patients with advanced/metastatic squamous cell NSCLC?

For a patient with stage III NSCLC who is treated with chemoradiation followed by surgery, when do you offer additional "adjuvant" chemotherapy after surgery?

Are you routinely offering nivolumab for second-line treatment of small cell lung cancer?

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

In newly diagnosed metastatic non-squamous NSCLC patients, which (if any) genomic targets are you routinely testing for besides EGFR and ALK?

What about specifically in never-smokers?

Do you ever offer adjuvant chemotherapy to patients with resected stage IB non-small cell lung cancer when the tumor is less than 4cm in size?

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

Is there a role for VeriStrat testing in determining when to use an EGFR TKI in previously treated squamous cell NSCLC?

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...

Would you offer adjuvant TKI to patients with Stage III, EGFR-mutant NSCLC after standard chemoradiation?

Would you offer adjuvant TKI following ADAURA data? Or proceed with durvalumab based on PACIFIC data?

For T1b or T2a NSCLC cancer, approached with SABR, should chemotherapy be considered in the adjuvant setting?

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

Should the incorporation of thoracic RT be standard in patients with extensive stage small cell lung cancer?

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...

How long do you continue maintenance chemotherapy for metastatic non-small cell lung cancer in patients who have achieved a radiographic CR?

Other than part of a clinical trial or for its FDA-approved indication (second-line therapy for metastatic squamous-cell NSCLC), when do you offer nivolumab to your patients with NSCLC?

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

What is the best adjuvant treatment for resected NSCLC?

Can chemotherapy be used instead of radiation therapy in a patient with extensive stage small cell lung cancer who presents with epidural spinal cord compression?

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...

When do you give treatment breaks for patients with NSCLC undergoing chemoradiation with serious toxicity?

Would you treat a patient with small cell lung cancer (limited to lung and mediastinum) but also with a malignant pleural effusion with upfront definitive thoracic chemoradiation?

If so, what would you include in the target and what dose?

Is there a role for post-operative chemoradiation therapy in fully resected, margin-negative T3N1 NSCLC?

What mutational testing is considered the standard of care for NSCLC?

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

How would you manage a patient with EGFR mutant adenocarcinoma of the lung on erlotinib with a single site of disease progression, but otherwise well-controlled disease?

Would you stop the Tarceva at this point?

Is it safe to give thoracic irradiation to a patient with lung cancer previously treated with a VEGF inhibitor?

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