Switching From Chemoimmunotherapy When a ROS1 Result Returns

Wade Iams, MD, says the guidance has changed on what to do when a ROS1 result lands after chemoimmunotherapy has already started. Clinicians once treated to maximal benefit of the initial regimen; for highly effective targeted agents he says therapy should stop and switch. Iams separates ROS1, EGFR, and ALK, where immunotherapy performs poorly, from KRAS, MET, and BRAF, where it can work, and says the distinction is essential once a driver turns up mid-treatment. Martin Dietrich, MD, PhD, says that when treatment cannot wait, chemotherapy alone is the safer opening, holding immunotherapy because of the pneumonitis and hepatitis risk that follows when a targeted agent is started afterward. He warns that symptomatic progression and falling performance status drive attrition between first and second line. Ticiana Leal, MD, adds that baseline brain metastases give another reason to switch.