Concurrent Versus Sequential Testing in NSCLC

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Corey J. Langer, MD, begins the conversation on concurrent versus sequential testing in non-small cell lung cancer (NSCLC) by stating that the biggest issue is timing. He recommends starting a patient on chemotherapy before receiving test resuts if a patient's performance status is declining too rapidly. However, if chemotherapy is started and the test for the EGFR mutation comes back positive, a tough decision remains regarding continuing chemotherapy or switching to the EGFR inhibitor erlotinib. Along these lines, Alan B. Sandler, MD, notes that he typically keeps the patient on at least two cycles of chemotherapy.

Mark A. Socinski, MD, says that part of the "art" of NSCLC management is not to prematurely abandon therapies that are working. Erlotinib, though a convenient second-line treatment, does have its toxicities and its administration should not be mandated.

Anne S. Tsao, MD, says that if a patient has an EGFR mutation at exon 19, she's in favor of using an EGFR mutation upfront followed by maintenance erlotinib. However, Socinski disagrees and says that for patients with an exon 19 deletion he would rather use chemotherapy first and save erlotinib until later.

David R. Gandara, MD, says that patients with EGFR mutations have low DNA repair and should respond better to platinum-based chemotherapy. One benefit of the Peer Exchange panel, Gandara says, is that he and his peers do not need to come to a consensus regarding which patients should finish chemotherapy or regarding any other topic.