Choosing Frontline Therapy Among the Approved ROS1 Inhibitors

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. He traces stepwise gains across the class, from repotrectinib at a little more than three years median PFS to a next-generation agent now beating four years, and draws the parallel to ALK-rearranged disease, where lorlatinib passed five years. Iams says the best agent performs best when used first. Martin Dietrich, MD, PhD, cautions that guideline listings and vendor reports run alphabetically rather than by efficacy, so position on the page says nothing about performance. He describes only two kinds of patients, those with brain metastases and those at risk of developing them. Ticiana Leal, MD, cites a frontline median PFS of 46.1 months.