How do you approach management of newly diagnosed locally advanced NSCLC in patients who are intubated for respiratory failure due to their disease burden?

There are a few other approaches that can sometimes help:

1. Interventional pulmonology can sometimes debulk tumor in the airway and/or place a stent.
2. I've had some success with intrabronchial brachytherapy as well.
3. I've had more success with 1-3 relatively large radiation fractions (4-6Gy).

However,...

Hospice.

This is a very challenging scenario. The only time when I've seen treatment helping in this specific setting is when targeted therapy can be done for EGFR, ALK, ROS1, etc, that time to response is short and the depth of response is dramatic. Unfortunately, NSCLC does not respond as fast as small cel...