Wade Iams, MD, says adding RNA-based next-generation sequencing (NGS) to DNA-based NGS identifies about 15% more patients with actionable fusions, and urges clinicians to confirm whether the panel they ordered includes RNA at all, since the report rarely makes that obvious.
Wade Iams, MD, says the guidance has changed on what to do when a ROS1 result lands after chemoimmunotherapy has already started.
Wade Iams, MD, says progression-free survival (PFS) drives his frontline choice, since median overall survival remains years away in ROS1-positive advanced non-small cell lung cancer and no head-to-head comparison exists.
Martin Dietrich, MD, PhD, says the first move at progression is to extend frontline therapy rather than abandon it, looking for oligometastatic patterns that stereotactic radiation can handle while the inhibitor continues; a patient progressing at four years with two or three new lesions is a candidate.
Wade Iams, MD, frames central nervous system management around radiation sparing.
Martin Dietrich, MD, PhD, says duration of response and progression-free survival converge in the untreated setting, because response rates approach the whole population, so the two numbers carry much the same information.
Martin Dietrich, MD, PhD, separates an agent working in the brain from an agent acting on the brain, and explains that structural overlap in the adenosine triphosphate (ATP) binding pocket makes TRK family inhibition difficult to avoid.
Martin Dietrich, MD, PhD, says he manages neurologic adverse events reactively rather than proactively, because he cannot predict who will develop them and because on-target effects tend to appear early.
Ticiana Leal, MD, argues that trials need more patient-reported outcomes and quality of life measures, since patients with ROS1-positive advanced non-small cell lung cancer now stay on oral therapy for years and the effect on daily life is poorly captured.
Martin Dietrich, MD, PhD, tells community oncologists to build in access to second opinions, often by telemedicine, and says he would rather be slow and right than fast and wrong, because a less effective first choice drives resistance that later agents cannot fully recover.
Martin Dietrich, MD, PhD, names testing as the first gap that remains, followed by a limited understanding of how resistance develops and when to retest.