Initial management of brain metastases from ROS1-positive NSCLC

For patients who are frail or prefer to avoid aggressive treatment, supportive care alone is an alternative option.

This algorithm applies to NSCLCs with an oncogenic driver alteration formed by a genetic translocation between ROS1 and other genes, the most common of which is CD74.

ROS1: c-ROS oncogene 1; NSCLC: non-small cell lung cancer; SRS: stereotactic radiosurgery; WBRT: whole-brain radiotherapy.

* For patients with a solitary brain metastasis, surgical resection may improve survival and may be an alternative option. Refer to the UpToDate discussion on oligometastatic disease and brain metastases.

¶ SRS is preferred over WBRT, when feasible. SRS versus WBRT is discussed in detail in the UpToDate overview discussion on treatment of brain metastases.

Δ If entrectinib is unavailable and the patient has not yet been treated with crizotinib, it is an acceptable alternative. Lorlatinib is another acceptable alternative, irrespective of whether patients have previously been treated with crizotinib.

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Initial management of brain metastases from ROS1-positive NSCLC