Extended Survival Raises New Questions on Imaging and Treatment Intensification in ROS1+ NSCLC

As patients with ROS1-positive non–small cell lung cancer (NSCLC) stay on tyrosine kinase inhibitors (TKIs) for years, Jorge Nieva, MD, says the long-term data do not change how disease is monitored. Progression can occur at any time with any cancer, so surveillance remains essential. What is changing is how patients think about it. ROS1-positive NSCLC is a disease of young people, and as survival is measured in years rather than months, concerns about radiation exposure from repeated scans are growing. Several of Nieva's long-term survivors on TKIs have asked whether they can move from CT scans every 3 months to every 6 months.

Those questions point to research that is still needed, Nieva says. This includes the role of deintensifying imaging and whether MRD testing could substitute for radiographic assessments, particularly for young patients who may be a decade or more into TKI therapy.

Looking ahead, Nieva describes a broader movement across TKI research to determine how chemotherapy and radiation therapy should be used to eradicate residual disease after initial induction treatment. The aim is the longest possible remissions, which Nieva says will likely involve some strategy of intensification, such as added chemotherapy or consolidative radiotherapy. "Time will tell" which approach is best.

Whatever the strategy, the overarching goal is for patients to stay on tolerable oral agents for years and decades. Nieva says maximizing that duration will be very important, which is why early management of treatment-related toxicity, including gastrointestinal effects, matters for keeping patients on therapy.

Read the full interview with Dr Nieva.