Operationalizing Screening for Non-Small Cell Lung Cancer: An International Discussion - Episode 9
The Urgency Dilemma: When to Start Treatment Before Biomarker Results
Experts debate the difficult practice of starting treatment before biomarker testing results are available. They acknowledge that in true emergencies—like symptomatic brain metastases or airway obstruction—immediate intervention with radiation is appropriate and can bridge the time needed for test results.
However, they strongly caution against starting chemotherapy solely due to patient anxiety. They emphasize that "chemotherapy is not good psychotherapy" and that every study shows patients do best with the right treatment first. Starting the wrong therapy can cause unnecessary toxicity, deteriorate a fragile patient's condition, and make it difficult to get "back on the right track" later. The consensus is to prioritize obtaining a comprehensive diagnosis and to use targeted interventions like radiation for urgent symptoms, thereby preserving the opportunity for the most effective personalized therapy once results are in.