Postoperative Pathways: Managing Treatment Surveillance and Recurrence Anxiety in ALK+ NSCLC скачать в хорошем качестве

Postoperative Pathways: Managing Treatment Surveillance and Recurrence Anxiety in ALK+ NSCLC

Stephen Liu, MD, of the Georgetown University Lombardi Comprehensive Cancer Center, joined Cancer Nursing Today at the 2025 International Association for the Study of Lung Cancer (IASLC) World Conference on Lung Cancer (WCLC) to moderate a panel focused on ALK-positive (ALK+) non–small cell lung cancer (NSCLC), as well as recent data released during the conference. The roundtable panel of multidisciplinary experts included perspectives from Mary Duffy, AM, RSCN, RGN, RSM, of the Peter MacCallum Cancer Centre, Shirish Gadgeel, MD, of the Henry Ford Cancer Institute, and Laura Macke, MS, FNP-C, of the MedStar Georgetown Lombardi Comprehensive Cancer Center. In the seventh segment of this roundtable series, the experts covered the post-surgical period, the impact of medication adherence on patient quality of life, monitoring scans for signs of recurrence in the adjuvant and metastatic settings, and helping patients manage anxiety surrounding scans. “If someone is asymptomatic from their cancer, you cannot make them feel better,” Dr. Liu explained. “You can make them feel worse, and we often do. It still may be causing the same amount of fatigue, but if you're starting with no fatigue, now you're in the minus. If you're starting with a lot of fatigue, maybe now you're in the plus. I would say my dose reduction rate's probably higher in the early stage than in the late stage. Laura, we're asking someone to take eight pills a day for 2 years. Is that something that people are going to be very hesitant to do, and is 2 years too long to ask for a therapy like that?” “I think it really depends on the patient,” Ms. Macke responded. “As you said, some patients might think ‘I'm cured. Why do I need to take all these pills every day?’ But a lot of patients also never want to do that again, so they're willing to do whatever it takes and to take the pills and to tolerate some of the toxicities. Again, I think the threshold of what is considered tolerable is a little different for those patients compared to the metastatic setting, but it can vary across the board. Generally, if patients are taking it, and they're tolerating it well, [they] will probably want to stay on longer than 2 years.” Dr. Liu shifted the conversation to monitoring practices for cancer recurrence and asked Dr. Gadgeel about his typical monitoring routine. Dr. Gadgeel highlighted that his surveillance approach for patients with ALK+ NSCLC is similar to his approach to other types of cancer but that he conducts heightened surveillance of the central nervous system (CNS) to help inform treatment options for potential recurrence in the brain. “I do some surveillance of the CNS, and I think that is one thing that is one of the concerns for me as a provider because I have seen, at least in stage IV disease, brain recurrence occur even 6, 7 years later, when other types of diseases are controlled,” Dr. Gadgeel explained. “When you look at the ALINA data, this was one area where there was a clear difference—that the CNS recurrence rate was significantly lowered with adjuvant alectinib as compared to adjuvant chemotherapy. There are still a lot of needs in advanced stage disease. I think this is one of our urgent needs in early-stage disease in ALK-positive lung cancer—whether it is minimal residual disease assessment or other such tools—to truly understand who is in need of adjuvant therapy because not everybody is in need of adjuvant therapy.”