Would you hold off on whole brain radiotherapy for a patient with metastatic NSCLC and multiple asymptomatic brain metastases and will be starting immunotherapy?

This is a very controversial area right now (as are most MedNet queries!). Given the data available and the opinion pieces by thought leaders right now on immunotherapy results in melanoma brain metastases, it would be very reasonable to hold off on WBRT for patients with asymptomatic melanoma brain...

Currently, assuming off protocol, I would not omit RT if the systemic therapy was immunotherapy. IT in melanoma brain metastases at least has a response rate of near 50% with combination ipi/nivo in prospective phase II data, and I have not seen data for RRs near that in NSCLC.

I think the data for...

The several answers above underscore the emerging conundrum and controversy. There is obviously no clear-cut correct or single answer and therefore one can opt to either wait and SRS later, or SRS up-front, and the choice will need to be individualized, and based on personal preference and logic. He...

In general, I agree with @Dr. First Last answer that delaying WBRT is an acceptable option these days.

There is some information missing though that can change opinion in either direction

1. What is the size of the mets?
   1. Very different approach if all BM are sub-cm vs larger
      1. Size in Lancet Oncol P2 tr...

Disease control in asymptomatic patients with small-volume brain disease is just as valuable as disease response.

Given that disease control of i/o + chemotherapy is much greater than the response rate and the quality of life consequences, I would hold radiation and follow closely. if the patient fo...