Dr. Otterson on When to Start Immunotherapy in NSCLC

Gregory A. Otterson, MD, professor of internal medicine, associate division director for Education, co-director of the Thoracic Oncology Program for the Division of Medical Oncology, and associate director for the Hematology and Medical Oncology Fellowship Program, The Ohio State University Comprehensive Cancer Center—James, discusses when to start treatment with immunotherapy in patients with non–small cell lung cancer.

Before starting a patient on immunotherapy or chemoimmunotherapy, it is important to have identified whether they harbor a targetable mutation, says Otterson.

In general, waiting to start immunotherapy until genetic testing results are analyzed optimizes treatment and spares patients from unnecessary toxicities, explains Otterson.

For example, patients who receive chemoimmunotherapy may develop severe hepatitis if they switch to a targeted therapy such as osimertinib (Tagrisso) in the presence of an EGFR mutation, says Otterson.

Chemotherapy alone can be given to patients who require immediate treatment. Immunotherapy can be added into the second cycle of therapy if testing for EGFR, ALK, RET, ROS, and NTRK comes back negative, concludes Otterson.