Dr. Dimou on Managing Disease Progression in NSCLC

Anastasios (Tassos) Dimou, MD
Published: Thursday, May 21, 2020



Anastasios (Tassos) Dimou, MD, a medical oncologist at Mayo Clinic, shares advice from managing patients with non–small cell lung cancer (NSCLC) who experience disease progression following therapy.

For patients who progress on therapy, one approach is to rebiopsy, if possible, says Dimou; a tissue biopsy, a liquid biopsy, or both can be used, says Dimou. Several factors should be considered when choosing a patient’s next line of therapy.

First, one must identify whether they are experiencing oligoprogression; in this case, a local approach like radiation and staying the course with the same TKI might be considered.

Another question to contemplate is whether comprehensive retesting with a rebiopsy would identify mechanisms of resistance, and whether that mechanism of resistance is target oncogene dependent or independent, adds Dimou.

Additionally, the question of whether the patients is dealing with progression in the brain or with disease in the brain should also be taken into consideration; in this case, the use of a CNS-penetrant TKI might serve as an effective approach, concludes Dimou.
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Anastasios (Tassos) Dimou, MD, a medical oncologist at Mayo Clinic, shares advice from managing patients with non–small cell lung cancer (NSCLC) who experience disease progression following therapy.

For patients who progress on therapy, one approach is to rebiopsy, if possible, says Dimou; a tissue biopsy, a liquid biopsy, or both can be used, says Dimou. Several factors should be considered when choosing a patient’s next line of therapy.

First, one must identify whether they are experiencing oligoprogression; in this case, a local approach like radiation and staying the course with the same TKI might be considered.

Another question to contemplate is whether comprehensive retesting with a rebiopsy would identify mechanisms of resistance, and whether that mechanism of resistance is target oncogene dependent or independent, adds Dimou.

Additionally, the question of whether the patients is dealing with progression in the brain or with disease in the brain should also be taken into consideration; in this case, the use of a CNS-penetrant TKI might serve as an effective approach, concludes Dimou.



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