David Carbone, MD, PhD: All these treatments have adverse effects, and many of our patients aren’t cured. It’s always a balance when we’re deciding on therapies between more aggressive treatments with an impact on quality of life and less aggressive ones with a potentially better quality of life. Dr Forde, what are the things you think about with quality of life in choosing regimens, particularly for patients [with] metastatic lung cancer?

Patrick Forde, MBBCh: It’s a key point, and I often try and put myself in the patient’s shoes to see what would make sense if I were sitting there or a loved one of mine [were] facing this. It’s a tough one. There is a history going back 30, 40 years where lung cancer has had a very bad prognosis. Slowly we’re coming out of that. But patients who’ve grown up in that in the past 50 years, they think [with] lung cancer [that] nearly everyone dies from it. [For] stage IV disease, we’re seeing at 5 years [that] maybe 15% of people are progression free with immunotherapy, for example, which isn’t something that’s broadly known. I explain those data, but I also explain to patients that it’s not an easy route. There’s a lot involved in coming to a clinic, having infusions, perhaps having some risk of immune toxicity or chemotherapy toxicity, and trying to get what their values are and [what] their families…value most. It might be different for someone who has 5 other comorbidities and is dealing with a lot of other things than someone who’s otherwise healthy and running marathons. It’s very individualized in terms of making those decisions.

David Carbone, MD, PhD: I’m very happy when I have someone with a PD-L1 [level] of 100% and I can avoid chemotherapy. You often see nice responses in those patients [with] high PD-L1 [levels]. We also have options of 6-week regimens. I live in a relatively rural area, and many of my patients drive hours each way to come and see me. Having a 6-week therapy option makes a difference in quality of life. But we are forced to become experts at managing adverse effects. In the old days, we didn’t even have antiemetics for our cisplatin regimens and people [experienced difficulty] with our therapies. But if you recognize these adverse effects and get on them early, you can often maintain that quality of life. It’s remarkable how many patients with metastatic lung cancer are getting optimal therapy and maintaining a high quality of life.

Transcript is AI-generated and reviewed by an AJMC editor.