Radical-Dose Image Guided Radiation Therapy in Treating Patients With Metastatic Non-small Cell Lung Cancer Undergoing Immunotherapy

Inclusion Criteria:

   1. Has stage IV non-small cell lung cancer, or initially stage I-III disease with distant
   metastatic recurrence

   2. Age ≥ 18

   3. Has been receiving anti-PD-1 or anti-PD-L1 immunotherapy for at least four weeks
   (refer to section 4.2.1)

   4. Has had restaging imaging after initiation of immunotherapy, at least 4 weeks after
   pre-immunotherapy baseline imaging. CT or PET/CT of at least chest/upper abdomen must
   be performed within 4 weeks prior to registration. For patients with history of brain
   metastases, brain MRI or CT is required within 4 weeks of registration; for other
   patients brain MRI or CT is required within 12 weeks of registration. Diagnostic
   PET/CT performed as part of radiation simulation can be used as the restaging imaging.

   5. Most recent imaging shows measurable disease as defined by RECIST 1.1

   6. Evaluation by a Stanford medical oncologist must show:

      1. The patient is expected to continue on immunotherapy for at least three more
      months

      2. Imaging must show response, stable disease, or modest progression

      3. If there is modest progression, the patient must be clinically stable in terms of
      performance status and overall disease-related symptoms

   7. Has at least one extracranial tumor safely treatable with radical-dose radiation
   therapy and that has not been previously treated with radiation

   8. ECOG performance status 0-2

   9. Has the ability to understand and the willingness to sign a written informed consent
   document.

Exclusion Criteria:

   - Untreated brain metastases, if not planned to be treated in this course of radiation
   therapy

   - Pregnancy or women of childbearing potential not willing/able to use contraception
   during protocol treatment