Knowing if you have ROS1-positive lung cancer is important no matter your stage of lung cancer. However, it has the most treatment implications for patients with advanced-stage lung cancer.
Treatment recommendations depend on the type of ROS1 fusion, how well you tolerate treatment, and whether the cancer has spread to the brain. Research on ROS1-positive lung cancer continues to evolve, and your treatment plan may differ from that of other patients.
First-Line Treatment
Patients with advanced-stage ROS1-positive lung cancer will likely be prescribed a ROS1 tyrosine kinase inhibitor (TKI), also called a ROS1 inhibitor.
Second-Line Treatment
Over time, the cancer may change and the ROS1 inhibitor may stop working. This can happen if the cancer develops a resistance mutation, a gene change that causes the cancer to stop responding to a certain drug.
To check for this, your doctor may recommend:
- Tissue biopsy
- Liquid biopsy
- Additional biomarker testing
If a patient develops resistance to a ROS1 inhibitor, treatment options may include:
- A clinical trial
- Switching to another ROS1-inhibitor
- Another targeted therapy that is considered off label.
(Off label means the therapy is approved to treat a different biomarker like ALK, but is not approved to treat ROS1.)
Third-Line Treatment
If the cancer continues to grow after second-line treatment, next options may include:
- A clinical trial
- Chemotherapy with or without a ROS1 inhibitor
- Chemotherapy with or without immunotherapy.
Brain Metastases
ROS1-positive lung cancer can sometimes spread to the brain, called metastasis. Cancer that has spread to the brain may be treated with:
- ROS1 inhibitors that can reach the brain
- Stereotactic radiosurgery (SRS), a type of brain radiation.
Clinical Trials
Research in ROS1-positive lung cancer continues to advance rapidly. Clinical trials are evaluating new therapies and approaches to help improve outcomes for patients with ROS1-positive lung cancer.
Ask your doctor whether a clinical trial may be appropriate for you.
Next Steps
Understand Your ROS1-Positive Lung Cancer
Learn about ROS1 biomarkers, testing, and what your results mean.
Learn About Biomarker Testing
Find out how biomarker testing can help guide treatment decisions throughout your care.
Explore Clinical Trial Options
See whether clinical trials may be an option for you.
Lung cancer research can move at a rapid pace. Always speak with your doctor about the most up-to-date treatment guidelines.
Page last updated: August 11, 2026
