Under what circumstances, if any, would you wait on initiating a TKI for metastatic recurrence of a Stage III NSCLC which occurred while on consolidative durvalumab to minimize pneumonitis risk?

Hepatotoxicity is of greater concern with ALK/ROS1 inhibitors. ALK inhibitors such as crizotinib or alectinib in combination with anti-PD1/PD-L1 agents led to higher than expected rates of hepatic and/or dermatologic AEs (Spigel et al., PMID 29518553; Kim et al., PMID 35875467).

The field has learne...

I agree with the answer. In patients with significant disease burden of recurrence, one may start with systemic chemotherapy as a bridge to TKI. Otherwise, as stated, one may consider SRS for oligometastasis.