Dr. Eric Singhi from MD Anderson Cancer Center moderated a virtual tumor board with Dr. Bruna Pellini and nurse practitioner Idalmis Hernandez from Baptist Health Herbert Wertheim Cancer Institute, Dr. Gregory Riedlinger from Rutgers Cancer Institute, and Dr. Estalamari Rodriguez from Sylvester Comprehensive Cancer Center.
The program covered the full management landscape for patients with ROS1-positive advanced non-small cell lung cancer (NSCLC), including disease epidemiology, preferred biomarker testing methods across immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), DNA-based and RNA-based next-generation sequencing (NGS), and liquid biopsy. The multidisciplinary team discussed frontline treatment selection with emphasis on CNS penetrance, toxicity profiles, and patient experience, with lorlatinib consistently emerging as the preferred agent. Two clinical scenarios—a newly diagnosed patient with high PD-L1 expression and osseous disease, and a previously treated patient with solvent-front resistance mutation and new intracranial progression—illustrated individualized decision-making. Insurance access barriers, bone-directed therapy, CNS surveillance strategies, second-line sequencing, the role of chemotherapy, and the rejection of immunotherapy monotherapy in ROS1-positive disease were discussed. Education and patient advocacy were identified as the primary unmet needs.
