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ROS1 NSCLC Crizotinib — SCE Medical Oncology MCQ

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HardLung CancerROS1 NSCLC CrizotinibSCE Medical Oncology

A treatment-naive patient has ROS1-positive metastatic lung adenocarcinoma and small asymptomatic brain metastases. Both crizotinib and entrectinib are available locally. Which statement best reflects current NICE guidance and rational selection?

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Correct answer: D — Choose the least-cost suitable ROS1 inhibitor, accounting for CNS disease and comorbidity

Current NICE positioning permits the least-cost suitable ROS1 inhibitor, with CNS activity, comorbidity, interactions and toxicity determining individual suitability. Choose crizotinib as the lower-cost ROS1 inhibitor when CNS disease is present: cost matters after suitability, while CNS activity is particularly relevant to this patient. Choose entrectinib as the CNS-active ROS1 inhibitor when comorbidity complicates treatment: CNS activity does not remove the need to consider toxicity, interactions and overall suitability. Choose lorlatinib as the default first-line ROS1 inhibitor under NICE guidance: lorlatinib is not ranked as routine first choice over both commissioned agents. Choose platinum-pemetrexed before a ROS1 inhibitor under NICE guidance: an eligible treatment-naive ROS1-positive patient can receive a matched TKI initially.

Reference: NICE TA1021 crizotinib for ROS1-positive advanced NSCLC (Published December 2024; current NICE TA): https://www.nice.org.uk/guidance/ta1021/chapter/1-Recommendations; NICE TA643 entrectinib for ROS1-positive advanced NSCLC (Published August 2020; current NICE TA): https://www.nice.org.uk/guidance/ta643/chapter/1-Recommendations