For patients with EGFR mutation positive NSCLC who progress on first line TKI without actionable resistance mechanisms, would you consider chemotherapy + targeted therapy as a second line option, or chemotherapy +/- immunotherapy?
Although the question assumes no actionable changes in the lung cancer, I do refer you to an excellent review of this topic, published last September (Piper-Vallillo et al., PMID 32552277), which included a table listing twenty-five open clinical trials for patients who have developed progression af...
This is certainly not an easy question. Assuming that the patient doesn't have an actionable targetable mutation, two important things that may be helpful to know in such cases are disease behavior and the status of disease in the brain.
If the disease is behaving aggressively, we SHOULD ALWAYS rule...
It is important to obtain a biopsy to rule out histologic transformation to small cell or squamous cell, which would impact chemotherapy drug choices. If not transformation and actionable mechanisms of resistance (MET amplification, BRAF, RET, or other targetable alterations) are ruled out, the main...