Oncology Brothers: Practice-Changing Cancer Discussions Managing Toxicities of ROS1 Inhibitors in Non-Small Cell Lung Cancer (NSCLC) – Dr. Estela Rodriguez
Nov 13, 2025
Join Dr. Estela Rodriguez, a thoracic oncologist at Sylvester Comprehensive Cancer Center, as she unpacks the nuances of managing ROS1 fusion positive non-small cell lung cancer. Discover the vital role of comprehensive NGS in treatment planning, and delve into the insights on various tyrosine kinase inhibitors like crizotinib and repotrectinib. Estela highlights common side effects, effective management strategies for toxicities, and the critical importance of patient education and regular follow-ups in optimizing care.
AI Snips
Chapters
Transcript
Episode notes
Do Baseline NGS And Pre-Treatment Counseling
- Do perform comprehensive NGS (tissue and liquid) for NSCLC to identify ROS1 fusions early.
- Do counsel patients about class side effects like visual changes, pneumonitis, QT and liver toxicity before starting therapy.
Crizotinib Is Less CNS Protective
- Crizotinib is an older, 'dirty' TKI with broader targets and more off-target toxicities.
- It provides less CNS protection than newer agents, so avoid it for younger patients with brain metastases.
Ramp, Monitor, And Reduce For Repotrectinib
- Do counsel patients starting repotrectinib about expected dizziness and balance issues and plan frequent follow-up during the first three months.
- Do consider dose reductions (160→120→80 mg) rather than stopping, since efficacy is often retained at lower doses.