Isabel Preeshagul, DO, MBS

Panelists discuss how financial toxicity and cost-effectiveness analyses highlight the importance of appropriate patient selection for perioperative immunotherapy, while emphasizing that multidisciplinary care and patient involvement remain essential for optimal outcomes.

Panelists discuss how stage IIIB treatment decisions require individual assessment, with surgery considered for selected T3/T4 tumors but not routinely for N3 disease, while postoperative radiation is generally not recommended.

Panelists discuss how to carefully manage radiation therapy after induction immunotherapy in surgically ineligible patients, treating only visible disease and considering additional immunotherapy based on patient tolerance and response.

Panelists discuss how restaging practices vary widely, with most favoring CT imaging over routine invasive restaging, while debating the optimal number of induction cycles (3 vs 4) and timing of surveillance.

Panelists discuss how the rapid integration of immunotherapy and targeted therapies into perioperative care requires constant practice updates and individualized decision-making based on pathologic response and patient characteristics.

Panelists discuss how multistation N2 disease is no longer an absolute contraindication to surgery, with treatment decisions based on biology rather than just nodal station number, though bulky vs invasive disease characteristics matter.

Panelists discuss how concurrent chemoradiation remains standard, when possible, with sequential approaches for frail patients, and consolidation immunotherapy recommended regardless of the initial radiation approach.

Panelists discuss how treatment selection for early-stage disease depends on lymph node metastasis risk, with SBRT considered for very low-risk peripheral tumors and surgery preferred when staging information is needed.

Panelists discuss how most patients with early-stage disease who would benefit from systemic therapy should receive neoadjuvant treatment, with direct surgery reserved mainly for those with medical contraindications to immunotherapy.

Panelists discuss how to pivot treatment plans when patients cannot proceed to surgery after induction therapy, emphasizing the importance of determining resectability up front and having multidisciplinary contingency plans.

Panelists discuss how resectability determination remains surgeon-dependent and institution-specific, requiring careful consideration of both technical feasibility (“can you”) and appropriateness (“should you”) for individual patients.

Panelists discuss how multidisciplinary coordination and early communication between surgical, pulmonary, and oncology teams ensures adequate tissue procurement for molecular testing from the initial biopsy.

Panelists discuss how to manage the waiting period for biomarker results while balancing urgency in curable patients, emphasizing the importance of tissue-based testing over liquid biopsies in early-stage disease.

Panelists discuss how surgeon-led ultrasound-guided biopsies can expedite care timelines and overcome barriers to guideline-concordant biomarker testing that still affects one-third of eligible patients.

Panelists discuss how comprehensive biomarker testing is essential for all patients with early-stage non–small cell lung cancer (NSCLC), with thoracic specialists emphasizing the importance of testing primary tumor samples and lymph nodes to identify actionable mutations that guide treatment decisions and inform patients about their therapeutic journey, particularly as targeted therapies and immunotherapies continue to advance in early-stage and locally advanced disease settings.

Panelists discuss how sequencing strategies for multiple HER2-targeted therapies will require careful consideration of patient characteristics, disease burden, and prior treatments, with oral tyrosine kinase inhibitors potentially preferred first due to better tolerability and CNS activity, while combination approaches remain investigational pending safety and efficacy data.

Panelists discuss how emerging oral tyrosine kinase inhibitors like zongertinib (HER2-selective) and sevabertinib (HER2/EGFR dual inhibitor) offer promising alternatives to antibody-drug conjugates with improved tolerability profiles, better central nervous system penetration, and robust response rates in the 60% to 70% range for second-line treatment.

Panelists discuss how interstitial lung disease represents a critical and potentially cryptic toxicity occurring in 10% to 15% of patients receiving HER2 antibody-drug conjugates, requiring vigilant monitoring, prompt recognition of subtle symptoms like dry cough, and aggressive management with steroids and pulmonary consultation.

Panelists discuss how antibody drug conjugates like trastuzumab deruxtecan work as “Trojan horses” to deliver chemotherapy directly to tumor cells, providing effective second-line treatment for patients with HER2-mutated disease but requiring careful management of chemotherapy-like adverse effects, including significant toxicities.

Panelists discuss how patients with HER2-mutated lung cancer represent a high-risk population with aggressive biology and propensity for brain metastases, currently treated with standard chemotherapy in the frontline setting while awaiting clinical trials that may move HER2-targeted agents to first-line treatment.

Panelists discuss how comprehensive next-generation sequencing testing is essential for identifying HER2 mutations in patients with stage IV non–small cell lung cancer, distinguishing between HER2 mutations (detected by DNA sequencing) and HER2 overexpression/amplification (detected by immunohistochemistry).

Isabel Preeshagul, DO, MBS, highlights the role of emerging therapies in the SCLC landscape, including tarlatamab and durvalumab.

Isabel Preeshagul, DO, MBS, and colleagues share updates from across the lung cancer space as discussed in a recent State of the Science Summit.

Isabel Preeshagul, DO, MBS; Catherine Ann Shu, MD; and Ashish Saxena, MD, PhD, discuss the latest findings in small cell lung cancer based on studies that were presented during the 2021 ESMO Congress, 2021 World Conference on Lung Cancer, and 2021 ASCO Annual Meeting.

Isabel Preeshagul, DO, MBS; Catherine Ann Shu, MD; and Ashish Saxena, MD, PhD, share insight on the data with novel targeted agents with impressive efficacy in patients with lung cancer, as seen at the 2021 ESMO Congress and the 2021 World Conference on Lung Cancer.

Isabel Preeshagul, DO, MBS; Catherine Ann Shu, MD; and Ashish Saxena, MD, PhD, highlight results with immunotherapy in the neoadjuvant and stage IV setting in lung cancer that were presented at the 2021 World Conference on Lung Cancer and the 2021 ESMO Congress.

Isabel Preeshagul, DO, MBS; Catherine Ann Shu, MD; and Ashish Saxena, MD, PhD, discuss breakthroughs in adjuvant immunotherapy in lung cancer from data presented at the 2021 ESMO Congress and 2021 World Conference on Lung Cancer.

Isabel Preeshagul, DO, MBS, discusses the need for more information about using biosimilars when treating patients with cancer.