Patient-Centered Factors Influencing Frontline Treatment Decisions in ROS1-Positive Advanced Non-Small Cell Lung Cancer: CNS Activity, Toxicity, and Access

Beyond efficacy, the panel identifies the key factors influencing agent selection: brain metastasis activity given the high prevalence of CNS involvement in younger ROS1-positive patients; toxicity profiles (earlier agents cause significant dizziness, taste changes, and neuropathic pain that are poorly tolerated chronically); frequency of clinic visits; and insurance access.

Insurance barriers are a prominent real-world challenge in South Florida's heterogeneous payer environment. Strategies for overcoming denials include peer-to-peer reviews, AI-assisted appeal letter drafting with embedded references, and compassionate use or patient assistance programs from manufacturers. The panelists describe instances where lorlatinib was obtained within 24 hours through manufacturer support programs while insurance decisions were pending, enabling rapid treatment initiation after receipt of molecular results. The panel emphasizes that these bridging access mechanisms meaningfully improve patient outcomes and quality of life during what can otherwise be an extended administrative delay.