Fascinating perspective. Could a lower dose of CRT be a feasible alternative? If we're excluding CRT entirely, does that imply stage III EGFR+ lung cancer is only treatable with palliative care? #LAURA #radonc @AcceleratorsRO
Fascinating perspective. Could a lower dose of CRT be a feasible alternative? If we're excluding CRT entirely, does that imply stage III EGFR+ lung cancer is only treatable with palliative care? #LAURA #radonc @AcceleratorsRO
@jryckman3 @AcceleratorsRO There is an effective cure rate with continuous TKI without any other therapy (ie 5 and 10 year PFS/OS) particularly for ALK but also for the other 1st line drivers, biology dependent but important to keep in mind when evaluating any local therapies.
@FordePatrick @jryckman3 @AcceleratorsRO Interesting concept @FordePatrick - “effective cure at 5 - 10 years”…. You probably have a very soecialised practice, but I think this describes the <1% outliers! I’d say TKI is generally accepted as non-curative? @DrewMoghanaki @TommyJohn00 @bensolomon1 @BrendonStilesMD
@_ShankarSiva @jryckman3 @AcceleratorsRO @DrewMoghanaki @TommyJohn00 @bensolomon1 @BrendonStilesMD On TKI but yes, ~1/3 of pts on ALK TKI without PD at 5 years in the Alex study cited earlier in thread. Now if you define cure as no evidence of radiographic cancer off all therapy that is different but the goal for most people are length and qualify of life.
@FordePatrick @jryckman3 @AcceleratorsRO @DrewMoghanaki @TommyJohn00 @bensolomon1 @BrendonStilesMD Interesting…. Lifelong therapy and associated toxicity for a curable disease stage (III) would be usually considered quality of life impairing. TKIs are not a free ride!
@_ShankarSiva @FordePatrick @jryckman3 @AcceleratorsRO @DrewMoghanaki @bensolomon1 @BrendonStilesMD This is something that we will have to discuss closely. There is tox from treatment and financial tox but is this trumped by being disease free? See @bensolomon1 excellent #ASCO23 discussion slide
@TommyJohn00 @FordePatrick @jryckman3 @AcceleratorsRO @DrewMoghanaki @bensolomon1 @BrendonStilesMD Agree - but the flip side is that the upfront Osi strategy versus salvage Osi for the subgroup that need it upon recurrence has not been compared…… not to mention overtreatment of a cohort of patients that never needed it in the first place!