Kristin Higgins, MD

The discussant of the abstract on repeat positron-emission tomography (PET) and/or computed tomography (CT) scans prior to chemoradiation in locally advanced non–small cell lung cancer, Kristin Higgins, MD, emphasized the importance of timing of imaging when staging patients and the need for increased awareness among payers and contractors. Dr. Higgins is Associate Professor of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta.

“As oncologists, we know that the timing of PET/CT matters, but do our Centers for Medicare & Medicaid Services (CMS) payers and Medicare contractors in our states understand this?” asked Dr. Higgins. “I think we all fight these battles frequently when trying to get patients enrolled in clinical trials that mandate PET/CT within 4 to 6 weeks of study registration. We certainly do not want to put our patients at increased financial burden when trying to obtain these PET/CT scans. So, it’s important that data such as these are published and that our CMS contractors are aware of them; we can use these findings as supportive data when we’re trying to get these PET scans approved.”

Timing of Treatment After Initial Staging

Although this study was unable to identify any clear imaging biomarkers for patients who were most at risk of being upstaged, Dr. Higgins stressed that a larger, prospective study might be able to uncover such biomarkers. In addition, Dr. Higgins underscored the need for patients with advanced cancer to begin treatment more quickly following initial staging.

“It’s unfortunate that most of our patients with stage III lung cancer are unable to get treatment within 4 weeks of a staging PET/CT,” commented Dr. Higgins. “I think our processes are somewhat inefficient when it comes to the staging workup. We all work very hard as oncologists to get these patients started [on treatment] as quickly as we can, but we owe it to our patients to make improvements in our processes. Then we can achieve a treatment start date within 4 weeks of an initial staging PET/CT.” ■

DISCLOSURE: Dr. Higgins is a consultant for AstraZeneca and Varian, is on advisory boards for Genentech and AstraZeneca, and has received research funding from RefleXion Medical.