NCCN guidelines recommend systemic therapy after first-line failure of a RET-specific TKI for RET rearrangement–positive adenocarcinoma. If there are no contraindications to PD-1 or PD-L1 inhibitors, preferred category 1 regimens for second-line treatment are pembrolizumab/carboplatin/pemetrexed or pembrolizumab/cisplatin/pemetrexed.
Other recommended category 1 second-line regimens are atezolizumab/carboplatin/paclitaxel/bevacizumab or nivolumab/ipilimumab/pemetrexed/(carboplatin or cisplatin).
After treatment failure with a RET-specific TKI, another drug in the same class may not be used in subsequent therapy.
Editor's Note: Skill Checkups are wholly fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.
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Cite this: John C. Leighton Jr. Skill Checkup: A 53-Year-Old Woman With Dry Cough and a Lung Lesion - Medscape - Sep 01, 2022.