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Lung Cancer • Thoracic Malignancies • Medical Oncology • NCI-CCC Tumor Board Question • Non-small cell lung cancer • Indiana University • NCI-CCC Thoracic Tumor Board Question
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, consider WBRT, or change systemic therapy (currently on pemetrexed and pembrolizumab)?
Answer from: Medical Oncologist at Academic Institution
The answer to this question would have been easy 10-20 years ago - you would give whole brain radiation. With the routine incorporation of SRS for brain mets and better systemic therapies, the trend over the last few years has been to go away from whole-brain radiation. Whole-brain radiation has bee...
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Answer from: Medical Oncologist at Academic Institution
I have had a few such patients recently, unfortunately. With systemic disease controlled outside of the brain, my approach has generally been to consider whole brain radiation. If this is refused or declined then I would change systemic therapy to include bevacizumab. Safety previously h...