Title options: 100-character limit, with spaces:
- The Role of the Multidisciplinary Team for ROS1+ NSCLC (54 characters)
- Optimizing Care for ROS1+ NSCLC Patients: The Importance of a Multidisciplinary Team (84 characters)
- The Impact of Multidisciplinary Collaboration on ROS1+ NSCLC Treatment (70 characters)
- Enhancing Care and Awareness for ROS1+ NSCLC from a Multidisciplinary Team Perspective (87 characters)
Outline:
- Intro:
- High-level overview of ROS1+ NSCLC
- Non-small cell lung cancer (NSCLC) is one of the most common types of lung cancer with many different subtypes that are caused by specific genetic changes.
- A ROS1+ diagnosis means that the tumor cells in the lungs have what is known as a ROS1 gene rearrangement, in which the ROS1 gene and another gene join, creating a fusion protein that causes cancer cells to grow.
- With a median age of 50, people diagnosed with ROS1+ NSCLC tend to be younger than the average lung cancer patient and have little to no history of smoking.
- High-level overview on how the 2024 NCCN guidelines recommend practicing in a multidisciplinary setting.
- High-level overview of ROS1+ NSCLC
According to key statistics from the American Cancer Society, lung cancer—both small cell and non-small cell (NSCLC)—is the second most common cancer in both men and women in the United States. Current data for 2024 estimate:
- About 234,580 new cases of lung cancer (116,310 in men and 118,270 in women)
- About 125,070 deaths from lung cancer (65,790 in men and 59,280 in women)
ROS1+ NSCLC
In ROS1+ lung cancer, the ROS1 gene fuses with another gene, often CD74, causing uncontrolled cell growth and cancer, according to the American Lung Society. This genetic change, known as a ROS1 fusion or rearrangement, leads to a standard treatment protocol for all ROS1+ patients, regardless of the type of ROS1 rearrangement.
The ROS1 gene is altered in about 1% to 2% of patients with lung cancer, typically in adenocarcinoma NSCLC. ROS1+ patients are generally younger and have little to no smoking history.
Multidisciplinary Treatment for ROS1+ NSCLC
In a recent update, the NCCN NSCLC Panel revised the algorithm for multiple lung cancers, recommending an initial multidisciplinary evaluation for suspected or confirmed cases. This evaluation aims to determine if lung nodules can be observed rather than misdiagnosed as stage IV NSCLC. The panel advises observing low-risk lesions, like small subsolid nodules with slow growth, but recommends treatment if lesions exhibit accelerating growth, increased solid components, or rising fludeoxyglucose uptake.
According to the NCCN, decisions about diagnosing suspected stage I to III lung cancer should involve thoracic radiologists, interventional radiologists, thoracic surgeons, and pulmonologists specialized in thoracic oncology. A multidisciplinary evaluation must include experts in advanced bronchoscopic techniques. The least invasive biopsy with the highest yield is preferred first. Bronchoscopy is recommended for central masses with suspected endobronchial involvement, and navigational bronchoscopy or transthoracic needle aspiration for pulmonary nodules. Endobronchial ultrasound, endoscopic ultrasound, navigational bronchoscopy, or mediastinoscopy are recommended for suspected nodal disease. Rapid on-site evaluation and thoracentesis with cytology are beneficial. Tissue confirmation is advised for suspected solitary or multiple metastatic sites.
A Deeper Look Into Multidisciplinary Importance
Physician’s Weekly (PW) spoke with Edgardo Santos, MD, medical oncologist and director of Broward County for the Oncology Institute of Hope and Innovation, to better understand why a multidisciplinary team approach is beneficial for patients with ROS1+ NSCLC and how they help improve patient outcomes.
Dr. Santos explains the crucial role of navigators in coordinating care and communication among the team and stresses the importance of holistic well-being, focusing not only on treatment but also on the QOL of the patient and their family.
PW: Given that ROS1+ NSCLC represents a rare patient population, do you have strategies that you employ to ensure a more timely and accurate diagnosis among those patients?
Dr. Santos: When we think about a patient with NSCLC in general, we must remember that at least two-thirds of those patients, especially in the adenocarcinoma histology, will drive or will have a driver mutation. When I say that driver mutation is a genetic alteration that makes lung cancer develop and progress. ROS1 is a rare mutation usually found in 1% to 2% of the NSCLC adenocarcinoma. Usually, patients are never smokers, but it can present in patients who smoked or are current smokers.
ROS1 is a driver mutation in adenocarcinoma of the lung. Its translocation is a fusion protein. As oncologists, we need to be careful when we analyze the patient tumor specimen and ensure that when we look for ROS1 or similar translocation, we use a technology that includes next-generation sequencing that includes both DNA and RNA.
We are sure that we will not miss this ROS1, so it’s important that we do that. However, sometimes it’s very difficult to reach that diagnosis. For example, suppose you have a long tissue biopsy that is small, so you can’t do an analysis from a molecular standpoint. In that case, I always suggest to my colleagues to repeat another biopsy or also go for a liquid biopsy to rescue this case and be sure that every patient this day can have a complete molecular profile.
Can you share with us any personal experience working on a multidisciplinary team and how do you feel that it enhanced the management for this patient population?
The multidisciplinary team is critical these days. There have been studies already shown that when a multidisciplinary team is present, which means a patient is in front of us and we have a thoracic surgeon, radiation oncology, the pulmonologist, the pathology team, and the medical oncology as well as other NCI support, like, psychology, social worker intervention, and radiology, the outcome of those patients is much better than when there is no formal multidisciplinary approach. It’s important that every single hospital or network has this multidisciplinary approach, not only for lung cancer but in general for all kinds of tumors that affect our population.
What are some of the key benefits that you’ve observed in patient outcomes when utilizing this team-based approach?
There are several. An advantage of having a multidisciplinary team is better patient care coordination. This is critical—the patient journey will be smooth. The patient feels more supported by healthcare professionals who will be there for them. Also, every single step because it’s not easy when we must diagnose and see how we will discover the true problem that the patient has and then deliver a therapy. It is not easy. When you have all those multidisciplinary disciplines involved, you can imagine everything will be easier for the patient. Also, for example, when we discuss in our tumor board with a multidisciplinary team present and the pathologists are there, they can tell us immediately whether the specimen is a good sample or not. Then, the medical oncology team can decide where the tumor specimen will go and what kind of platform we can use. Can we use next-generation sequencing that needs a little bit more tissue? Can we do a PCR multiplex technology?
Immediately, you sense that everything is moving forward at the same time. If there is any discrepancy in the management of the treatment, the thoracic surgeons and the radiation oncologists are there. If we need more tissue, then you have the interventional team ready to say, yes, we can do this biopsy, or no, it is better to send the patient to the thoracic surgeon for an endobronchial endoscopy.
The new era of lung cancer treatment is, I would say, a little bit more aggressive in the sense that now we have better therapeutic options for patients who were not resectable in the past. Perhaps they may have a chance to go for surgery this time, or the outcome in those patients that surgical candidates have shown to be better when we apply a new adjuvant approach, which means therapy in front of surgery.
Additionally, given the new data that have been developed in the last year and this year, the concept of a preoperative approach, it is very important that every patient with early-stage lung cancer is presented in a tumor board in the presence of a thoracic surgeon, radiation oncology, and the medical oncology team.
How do you stay updated on the latest advancements and best practices for managing this specific subset of patients?
By training, I am a lung cancer expert. Lung cancer has been my passion in terms of doing research and treating patients for more than 20 years.
However, there are several ways to keep track of all these developments. One is to join associations such as the American Society of Clinical Oncology. Although you do not necessarily need to attend their annual meeting in June in Chicago, you can gain access to all the presentations visually. Virtual presentations give us the advantage that you can connect with experts anywhere in the world by doing online webinars or online training.
Additionally, regional meetings every day are important. Here in South Florida, we have different consortiums, organizations, and educational vendors that offer continued medical education activities every weekend. We also need to recognize that there are several other organizations specifically focused on lung cancer, like the Lung Cancer Foundation.
What strategies do you use to ensure clear communication and consistent coordination among the care team, especially during those care transitions?
We go back to the multidisciplinary team, and one important individual on the team is the navigator. The navigator is a person, usually a well-trained nurse, who coordinates all the care and communication between the divisions that will treat the patient.
If you are a hospital administrator and you want to have a stellar tumor board and multidisciplinary team, I advise you to please remember that navigators are essential and crucial to a successful program in any hospital or cancer center.
How do you prioritize the holistic well-being of patients with ROS1+ NSCLC regarding supportive care measures?
Depending on where you are practicing, if you are in a well-structured cancer center, we need to involve, as I mentioned before, a social worker and dietician. Some of our cancer centers also have integrative mapping that can provide the patient with a holistic approach, which is an adjuvant to this therapy that we will provide to patients with ROS1, altering the ROS1 by itself. There is also a page on Facebook for the public and one for a patient who has this ROS1 alteration.
There are a lot of places where patients can get information from and perhaps share their experiences.
Everything depends on what kind of resources your hospital or cancer center has, and with this, we can provide the patient with integral therapy. We should not only focus on the treatment itself but also on what is beyond the therapy. What is the patient’s QOL, and how can we care for them?