Medical Oncology

Lung Cancer   

Questions discussed in this category



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

How do you decide between entrectinib or crizotinib? Since no head-to-head comparison, can real-world datasets (such as Doebele et al., Journal of Cli...

Are there specific patient factors for which you would more preferentially use this regimen?

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...

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

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

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 ...

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

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

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

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...

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...

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

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

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

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

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

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

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...

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

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...

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...

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

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

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

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

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

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

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

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

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

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

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

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...

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?

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?

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?

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. 

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

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...

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

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


International journal of radiation oncology, biology, physics, 2013-09-01

N Engl J Med, 2007 Aug 16

J Clin Oncol, 1999 Jul

Lancet, 2015 Jan 3

International journal of radiation oncology, biology, physics, 2011-11-01

Int. J. Radiat. Oncol. Biol. Phys., 2006-09-01

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2017-12

Lancet Oncol., 2017-05-01

The New England journal of medicine, 1999-08-12

BMC Cancer, 2015-08-15

Journal of cancer research and therapeutics, 2012

International journal of radiation oncology, biology, physics, 2012-05-01

Neurosurgery, 2013-10

Practical radiation oncology, 2015

J. Neurosurg., 2005-01-01

J Korean Neurosurg Soc, 2011-08-01

Radiat Oncol, 2014-07-08

BMC Cancer, 2015-03-04

Acta Neurochir (Wien), 2013-01-01

The Lancet. Oncology, 2009-11

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2007-04-01

J Clin Oncol, 2011 Jan 10

JAMA, 2016-07-26

Radiation oncology (London, England), 2014-09-30

Cancer, 2016-06-15

J. Clin. Oncol., 2018 May 22

Lung cancer (Amsterdam, Netherlands), 2018-06

The New England journal of medicine, 2018-08-23

The New England journal of medicine, 2018-12-06

International journal of radiation oncology, biology, physics, 2019-04-01

Lancet, 2019 Oct 04

JAMA oncology, 2019-06-01

International journal of radiation oncology, biology, physics, 2019-04-01

International journal of radiation oncology, biology, physics, 2019-04-01

Neurosurgery, 2019 Oct 10

JAMA Oncol, 2020 Jun 4

J Clin Oncol, 2020 Aug 10

Lung Cancer, 2014 Aug 02

N Engl J Med,

Lancet Oncol, 2020 Apr 03

Int J Radiat Oncol Biol Phys,

JAMA,

J Neurosurg,

Cancer,

N Engl J Med, 2014 Sep 27

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-07-01

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.,

Journal of the National Comprehensive Cancer Network : JNCCN, 2018-10

JAMA Netw Open, 2019 Aug 2

Pract Radiat Oncol, 2020 May - Jun

J Thorac Oncol, 2021 Feb 02

J Clin Oncol, 2021 Jan 27

Int J Radiat Oncol Biol Phys, 2020 Nov 18

J Clin Oncol, 2021 Aug 11

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

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

Semin Radiat Oncol, 2015 Oct

Lancet Oncol., 2014 May 13

The Lancet. Oncology, 2015-08

Nature reviews. Rheumatology, 2022 Oct 05

Oncoimmunology, 2023 Oct 30

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

Journal of the National Cancer Institute, 2007-03-21

The Lancet. Oncology, 2015-07

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

JCO Precision Oncology, 2017 Sep 29

Sci Rep, 2014 Sep 09

Medicine (Baltimore),

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

Blood, 2015-07-23

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2024 Jun 03

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2021 May 11

Cancer Treat. Rev., 2016-04-01

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

Clin. Cancer Res., 2015-04-15

Eur. J. Cancer, 2016-02-01

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

Immunotherapy, 2016-10

J. Clin. Oncol., 2020 Feb 14

Neuro Oncol,

J Clin Oncol, 2021 Aug 11

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.,

Radiographics : a review publication of the Radiological Society of North America, Inc, 2014-10

Oncotarget,

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 Thorac Oncol, 2016 Oct 07

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-04-01

J. Natl. Cancer Inst.,

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2017-10

Advances in radiation oncology, 2017

Cancer, 2010 Aug 27

J. Clin. Oncol.,

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

Science translational medicine, 2013-12-18

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2013-02

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

J Thorac Oncol, 2018 Feb

Lung Cancer,

Lancet Oncol., 2008 Jun 24

Lancet (London, England), 2009-03-28

Annals of oncology : official journal of the European Society for Medical Oncology, 2015-09

N Engl J Med, 2020 Sep 19

Lancet, 2021 Sep 20

J Clin Oncol, 2020 Dec 17

JAMA oncology, 2017-05-01

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

J. Clin. Oncol., 2015 Nov 02

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2017-10

J Thorac Oncol, 2020 Sep 08

Lung Cancer, 2017 Jun

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

The Journal of molecular diagnostics : JMD, 2018-03

Ann Oncol, 2020 Feb 06

Acta Cytol, 2021 Jul 07

N Engl J Med, 2021 Sep 18

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-11-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-11-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2007-01-20

Br J Cancer,

The New England journal of medicine, 2016-03-03

Cancer immunology, immunotherapy : CII, 2017-01

Cancer, 2017-06-01

Journal of the American Academy of Dermatology, 2019-07-11

J Immunother,

Oncologist, 2020 Feb 11

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2014-06

Radiother Oncol, 2020 Jul 31

Int. J. Radiat. Oncol. Biol. Phys., 2008-11-01

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

The New England journal of medicine, 2017-08-31

N Engl J Med,

Lancet, 2017 Jan 24

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2018-08

J Thorac Oncol, 2021 Jul 08

J Thorac Oncol, 2016 Apr 16

J Thorac Oncol, 2018 Jun 05

J Clin Oncol, 2021 Mar 01

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2018-11

Annals of oncology : official journal of the European Society for Medical Oncology, 2019-08-01

J Thorac Oncol, 2020 Jan 13

J Immunother Cancer, 2019 Jan 21

ESMO Open, 2021 Aug 31

Am Soc Clin Oncol Educ Book,

Ann Oncol, 2013 Mar 01

N Engl J Med, 2022 Apr 11

N Engl J Med, 2022 Jun 03

J Clin Oncol, 2022 Jun 03

Lung cancer (Amsterdam, Netherlands), 2017-10

J Thorac Oncol, 2017 Oct 31

Lancet (London, England), 2014-08-23

Lancet (London, England), 2019-05-04

International journal of radiation oncology, biology, physics, 2015-06-01

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

N Engl J Med, 2021-04-01

Lancet Oncol, 2021 Dec 15

Lancet Oncol,

N Engl J Med, 2021 Jun 24

Ann Oncol, 2022 Feb 14

J Clin Oncol, 2021 Dec 20

J Natl Compr Canc Netw,

J Immunother Cancer, 2021 Jun

Ann Oncol, 2022 Oct 18

ESMO Open, 2021 Sep 17

The Lancet. Oncology, 2015-02

Eur Respir J, 2005 Aug

N Engl J Med, 2023 Jun 28

The New England journal of medicine, 2018 Apr 16

The Lancet. Oncology, 2020 May 07

Translational lung cancer research, 2019 Sep

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2009 Aug 21

Cancers, 2021 Sep 26

Clinical lung cancer, 2023 Jul 25

ERJ open research, 2020 Feb 17

Clinical Medicine Insights. Oncology, 2023 Feb 14

Chest, 2016-03

Chest, 2008 Feb 08

JAMA, 2010 Nov 24

N Engl J Med, 2021 Jun 04

Journal of clinical pharmacology, 2018-12

Investigational new drugs, 2023 Apr 13

Case reports in oncology, 2021 Mar 01

JAMA Oncol,

The New England journal of medicine, 2023 Jun 03

N. Engl. J. Med.,

Acta oncologica (Stockholm, Sweden), 2019 Jul 18

J Thorac Oncol, 2023 Feb 23

J Clin Oncol, 2023 Jan 31

Cancer journal (Sudbury, Mass.), 2020 Nov/Dec

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2021 Feb 12

Journal for immunotherapy of cancer, 2021 Aug

International journal of cancer, 2019 Feb 19

The Lancet. Respiratory medicine, 2023 May 05

Current oncology (Toronto, Ont.), 2015 Apr

Nature reviews. Cancer, 2007-10

N. Engl. J. Med., 2020 Jan 29

The Lancet regional health. Europe, 2021 Sep 11

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2018 Nov 13

Translational lung cancer research, 2020 Feb