Local Therapy and TP53 in a High-Risk First-Line Decision

Siddhartha Devarakonda, MD, of Providence Swedish Cancer Institute says he tries not to push patients with asymptomatic brain metastases from epidermal growth factor receptor (EGFR)-mutated advanced non–small cell lung cancer (NSCLC) toward local therapy, calling whole brain radiation the wrong step for this patient and noting that another consultation costs the patient time. Matthew Gumbleton, MD, PhD, of Huntsman Cancer Institute adds that targeted therapy can usually start faster than radiation and that patients respond and feel better sooner, with surgical need being the clear exception. Estelamari Rodriguez, MD, MPH, of Sylvester Comprehensive Cancer Center describes sharing the intracranial data directly with radiation oncology colleagues and repeating imaging at 6 weeks. On TP53, Dr Devarakonda says it would not change this patient's plan but could tip the decision in an older patient with low disease burden and no other risk feature.