Expert Cancer Panel: Recurrent adenocarcinoma s/p pneumectomy, RT and SBRT, currently on osimertinib

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Published
Recorded on 3/13/2021

70-year-old female with recurrent adenocarcinoma following right pneumectomy, hemithorax radiation and stereotactic body radiation to the left lung twice, currently on osimertinib

Summary:
- Prior radiotherapy does not preclude additional courses; when assessing whether repeat radiotherapy is contraindicated, what matters is the effective dose to critical structures such as the airway or blood vessels
- Proton therapy or SBRT may be considered for reirradiation
- The mechanism of acquired resistance should be determined via tissue sampling prior to recommending a switch in immunotherapy, as acquired resistance following osimertinib may be due to a multitude of mutations. If this cannot be ascertained, cytotoxic chemotherapy is the next step, with a regimen of carboplatin and pemetrexed recommended with continued osimertinib.
- Bevacizumab may be considered as an adjunct, but there are no data to support its use at this time.


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Category
Oncology
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