Jonathan Wesley Riess, MD, MS

An expert discusses the personalized approach to treating ROS1-positive non-small cell lung cancer, emphasizing the preference for next-generation TKIs like talotrectinib and repotrectinib due to their CNS activity and efficacy against resistance mutations, particularly G2032R, while highlighting the importance of molecular profiling, avoiding immunotherapy, and considering clinical trials or chemotherapy in later-line settings.

An expert discusses the 2025 NCCN guideline updates for ROS1-positive non-small cell lung cancer, highlighting the inclusion of talotrectinib and repotrectinib as preferred first-line therapies due to their high efficacy and CNS activity, the shift away from older agents like crizotinib and ceritinib, and the critical importance of early molecular testing to guide targeted treatment and avoid immunotherapy in this population.

An expert discusses the evolution of ROS1 testing in non-small cell lung cancer, highlighting the shift from FISH-based methods to comprehensive next-generation sequencing of both tissue and plasma, emphasizing RNA-based assays for detecting gene fusions, and stressing the importance of early molecular testing to guide targeted therapy selection and improve patient outcomes.