Case for Stopping Targeted Therapy When Lung Cancer Progresses on Treatment in Hospice-Eligible Patients.

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During the process of developing the 2017 update1 of the 2015 ASCO stage IV lung cancer guidelines,2 the ASCO Expert Panel discussed the topic of stopping the administration of tyrosine kinase inhibitors (TKIs) after clear-cut generalized disease progression in patients eligible for hospice and who do not have other treatment options. This is important, because the high cost of TKIs (often > $500 per day) is prohibitive for the hospice per diem of $190 per day.3 If it is safe and reasonable to stop the administration of TKIs, it would enable more people to use hospice when appropriate. This is important because hospice for patients with lung cancer improves care,4 saves money for society—and ultimately results in more anticancer treatments—by avoiding end-of-life hospitalizations,5 and is associated with improved survival.