Dr. Wakelee on Immediate Therapy Options in Lung Cancer

Heather A. Wakelee, MD
Published: Monday, Feb 10, 2020



Heather A. Wakelee, MD, medical oncologist, thoracic specialist, professor of medicine at Stanford University Medical Center, discusses therapy options when patients with lung cancer must receive treatment options immediately rather than wait for molecular testing results.

In newly diagnosed patients, when considering therapies and how long they can wait before receiving treatment, the physical factors of the disease must be considered, explains Wakelee. Some patients, by the time they physically present, are very ill with tumor burden, have painful bone metastases, liver metastases, or difficulty breathing. Patients who are symptomatic may not be able to wait for their mutational test results before receiving treatment, says Wakelee.

Patients who must have treatment immediately after diagnosis and may have a high chance of having a driver mutation can receive chemotherapy and maybe bevacizumab (Avastin), but not immunotherapy, according to Wakelee. Patients with driver mutations may react poorly to immunotherapy, further delaying their targeted treatment, she says.

Meanwhile, patients who are unlikely to have driver mutations can receive chemotherapy plus immunotherapy, Wakelee says. In some cases, payers will not cover chemoimmunotherapy until the patient is confirmed to have no driver mutation. In that situation, patients can always receive chemotherapy, which may not be ideal, but is never a wrong choice, concludes Wakelee.


Heather A. Wakelee, MD, medical oncologist, thoracic specialist, professor of medicine at Stanford University Medical Center, discusses therapy options when patients with lung cancer must receive treatment options immediately rather than wait for molecular testing results.

In newly diagnosed patients, when considering therapies and how long they can wait before receiving treatment, the physical factors of the disease must be considered, explains Wakelee. Some patients, by the time they physically present, are very ill with tumor burden, have painful bone metastases, liver metastases, or difficulty breathing. Patients who are symptomatic may not be able to wait for their mutational test results before receiving treatment, says Wakelee.

Patients who must have treatment immediately after diagnosis and may have a high chance of having a driver mutation can receive chemotherapy and maybe bevacizumab (Avastin), but not immunotherapy, according to Wakelee. Patients with driver mutations may react poorly to immunotherapy, further delaying their targeted treatment, she says.

Meanwhile, patients who are unlikely to have driver mutations can receive chemotherapy plus immunotherapy, Wakelee says. In some cases, payers will not cover chemoimmunotherapy until the patient is confirmed to have no driver mutation. In that situation, patients can always receive chemotherapy, which may not be ideal, but is never a wrong choice, concludes Wakelee.

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