Evaluating Next-Line Options in HER2-Expressing NSCLC With Pulmonary Comorbidities

In this segment, Dr. Jacob Sands begins a structured assessment of next-line therapy for a patient with HER2-expressing metastatic non-small cell lung cancer and multiple pulmonary risk factors. He reiterates that the patient has mild COPD, an ECOG 2 performance status, and a history of immune-related pneumonitis from prior checkpoint inhibitor therapy. Because she has already received two lines of systemic treatment, Dr. Sands emphasizes the importance of reviewing how she tolerated earlier regimens, particularly whether her pneumonitis resolved quickly with steroid intervention and whether any residual respiratory compromise remains. This retrospective evaluation helps determine how aggressively clinicians can pursue HER2-directed options, especially given the potential for TKI-associated pulmonary events. The discussion sets up a nuanced decision-making framework focused on balancing efficacy, safety, and quality of life as the therapeutic landscape for HER2-expressing NSCLC continues to evolve.