Grid Radiation Therapy for the Treatment of Stage IV Non-Small Cell Lung Cancer

PRIMARY OBJECTIVE: I. To describe the safety and toxicity of grid + immunotherapy in stage IV NSCLC using any Common Terminology Criteria for Adverse Events (CTCAE) version (v)5.0. SECONDARY OBJECTIVE: I. Evaluation of objective response rate using Immune-based Response Evaluation Criteria in Solid Tumors (iRECIST) in non-irradiated lesion(s) after grid therapy in the setting of ongoing immunotherapy. CORRELATIVE RESEARCH: I. Monitoring of peripheral blood T cell activation and immunity markers before and after grid therapy. II. Evaluation of objective response rate using RECIST in the irradiated lesion after grid therapy. III. Evaluation of time to change in systemic therapy. IV. Evaluation of overall survival. OUTLINE: Patients undergo grid radiation therapy over a single fraction on day 1 and palliative radiation therapy over 5 fractions on days 2 and -1 post-grid in the absence of disease progression or unacceptable toxicity. Patients also receive SOC immunotherapy and undergo computed tomography (CT) at the discretion of the physician and undergo blood sample collection throughout the study. After completion of study treatment, patients are followed up at 30 days then every 8-12 weeks and every 3 months up to 5 years.