GRACE :: Lung Cancer

ALK Rearrangement

Denise Brock

Lung Cancer Video Library – Spanish Language: Video #17 First Line Therapy for NSCLC Patients That Have Anaplastic Lymphoma Kinase (ALK) Positive

Share
 
GRACE Cancer Video Library - Lung

 

For our 17th video in the GRACE Spanish Lung Cancer Library, Dr. Brian Hunis, Medical Director, Head and Neck Cancer Program, Memorial Cancer Institute, Miami, Florida, joined GRACE to discuss the basics of Lung Cancer for Spanish-speaking patients and caregivers.  In this video Dr. Hunis speaks about first line therapy for non-small cell lung cancer patients that have anaplastic lymphoma kinase (ALK) positive.


 

 

 

 


 

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.


 

TRANSCRIPTS – Spanish and English
download transcripts

Terapia de primera línea para pacientes con cáncer pulmonar de células no pequeñas que presentan la cinasa de linfoma anaplásico (CLA) positiva.

En los pacientes en los cuales uno describe que el adenocarcinoma de pulmón de células no pequeñas tiene la translocación del gen ALK, hay terapia dirigida que atacan exclusivamente a las células que expresan esa mutación. Por lo cual los efectos adversos, la toxicidad y las respuestas son muchísimo mejores.

La primera terapia para pacientes con translocación en ALK que se ha usado en el mundo es con crisotinib. Crisotinib es una píldora que se toma diariamente, es bien tolerada y con efectos muy positivos.


First line therapy for non-small cell lung cancer patients that have the anaplastic lymphoma kinase positive.

In patients that have adenocarcinoma of non-small cells and also have the ALK gene translocation, there is a targeted treatment that only attacks the cell that express this mutation. So, the side effects, toxicity and the response are better.

The first therapy for patients with the ALK translocation that has been used in the world is with crisotinib. Crisotinib is a pill that is taken daily, is well tolerated and with very positive effects.


Denise Brock

Lung Cancer Video Library – Spanish Language: Video #16 ALK Rearrangements: What Are They and Which Patients Have Them?

Share
 
GRACE Cancer Video Library - Lung

 

For our 16th video in the GRACE Spanish Lung Cancer Library, Dr. Brian Hunis, Medical Director, Head and Neck Cancer Program, Memorial Cancer Institute, Miami, Florida, joined GRACE to discuss the basics of Lung Cancer for Spanish-speaking patients and caregivers.  In this video Dr. Hunis speaks about ALK rearrangements, what they are and who has them.  


 

 

 

 


 

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.


 

TRANSCRIPTS – Spanish and English
download transcripts

Reacomodos de la Cinasa de Linfoma Anaplásico (CLA): ¿Qué Son? Y ¿Qué Pacientes la Tienen?

El cancer de pulmón de células no pequeñas ha demostrado tener mutaciones genéticas que hacen que ese cancer se pueda desarrollar y crezca. Una de esas mutaciones presente en menos del 10% de los pacientes es la mutación o translocación del gen ALK.

Es mutación o translocación permite que una proteína oncogénica se desarrolle, con lo cual los pacientes están predispuestos a desarrollar cancer de pulmón de células no pequeñas.

Por lo general, esos son pacientes no fumadores, de sexo femenino o con una historia remota de consumo de tabaco de forma remota o muy limitada.


Rearrangements of the Anaplastic Kinase Lymphoma (ALK): What Are They? And, What Patients Have Them?

Non-small cell lung cancer has proved to have many mutations that make the cancer develop and grow. One of these mutations is in less than 10% of them and it’s the mutation or translocation of the ALK gene.

This mutation or translocation allows an oncogenic protein to develop, so these patients will be predisposed to develop non-small cell lung cancer.

In general, these are non-smokers, feminine patients or with a history of limited tobacco consumption.


Dr West

Is immunotherapy the wrong choice for some lung cancer patients?

Share

Amidst all of the glowing reports about immunotherapy for lung and many other cancers, it would be understandable for patients and physicians to be tempted to rush toward prioritizing immunotherapy as the first treatment strategy to pursue. In fact, a highly publicized trial called KEYNOTE-024 was just presented at the ESMO meeting in Copenhagen and demonstrated a significant improvement in progression-free and overall survival over standard chemotherapy doublet treatment as the first line approach for patients with high level expression of the PD-L1 protein on their tumor (about 30% of patients).  But there is also converging evidence that some patients are consistently less likely to benefit from immunotherapy — specifically, those patients with an EGFR mutation and perhaps others with another “driver mutation” such as an ALK or ROS1 rearrangement.  This is an important issue to know, because I and some other lung cancer specialist colleagues see patients with one of these highly targetable lesions sometimes being mistakenly recommended immunotherapy over the optimal targeted therapy for their cancer, or patients deflect a recommendation for an EGFR or ALK inhibitor in favor of immunotherapy based largely or completely on the hype around the latest new idea in cancer treatment.

Continue reading


GRACE Video

Timing of Second Generation ALK Inhibitors: First Line vs. Treatment after Acquired Resistance

Share
GRACE Cancer Video Library - Lung

GCVL_LU-FC02b_Second_Gen_ALK_Timing_First_Line_Acquired_Resistance

 

Dr. Ross Camidge, University of Colorado, addresses the question of whether to use a second generation ALK inhibitor as first line therapy or only after acquired resistance to crizotinib.

Download Transcript

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.

 

Transcript

One of the long-standing philosophies in oncology is you use your best drugs first. To be honest that goes back to a mindset that maybe people weren’t going to survive for you to try a treatment in a second line or third line setting, so you were just trying to get in your best drug in whilst you had a chance. Now we’ve seen with the next generation ALK inhibitors, they have better activity in the brain, they have activity after crizotinib has stopped working, so the logical question is, what if you come in with these drugs first instead of crizotinib? Could they displace the recently crowned king of ALK crizotinib by being the new pretender? Well, maybe.

The only direct head to head study is with alectinib and that’s the so-called ALEX study — alectinib, ALE, compared to crizotinib which is also called Xalkori and that’s where the X comes from — ALEX. There’s a very similar study run in Japan which is called the J-ALEX study. Both of those have finished accrual, so we should see those results in the near future.

Now, when we get that data it’s going to be very interesting to look at. Does the alectinib just have to be better that the crizotinib? Well, sure, it probably has to be and it probably will be. The real question is, how much better? If it’s just a little bit better, sure that’s a positive study, they’ll get a license for the drug, but you could still use crizotinib followed by alectinib, or followed by any other second generation ALK inhibitor, and maybe that sequential benefit may be more than if you use your best card up first.

What if it’s the same as the sequential therapy? Well that might change peoples’ prescribing if the drug is better tolerated, more convenient, or cheaper, and new drugs tend not to be cheaper. Perhaps what we’re hoping for is that by suppressing some of the dominant mechanisms of resistance from the get go, we’ll actually change the natural history of the disease. Every time resistance occurs, more cells divide, they grow up, and they’re generating the next and the next mechanism of resistance.

So the more you can suppress cell turnover from the get go, the more maybe you can extend out the overall duration of control — but we have to wait for those results to come out and until they come out, I wouldn’t start using second generation inhibitors in the first line setting without that data.


GRACE Video

CNS Disease in ALK-Positive NSCLC: Monitoring and Systemic vs. Radiation Therapy

Share
GRACE Cancer Video Library - Lung

GCVL_LU-FC05_CNS_Disease_ALK-Positive_NSCLC_Monitoring_Systemic_Radiation_Therapy

 

Dr. Ross Camidge, University of Colorado, discusses management of CNS progression for ALK-positive NSCLC including monitoring frequency and preferences between systemic and radiation therapy.

Download Transcript

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.

 

Transcript

As we started to treat ALK-positive patients with crizotinib, it became clear that the brain was somewhat of an Achilles heel. It was a common site for people, when their cancer started to grow, for that to be the site where their cancer was growing, and we know that in many of those cases that’s the only site where the cancer is growing. We know from a small number of studies where people have actually sampled blood levels and from the fluid around the brain that actually very little of the crizotinib is getting in, so it’s maybe just that you have a relatively under-treated part of you.

Now that plus the fact that people fortunately live a long time with ALK-positive lung cancer means that the brain can become this area that will crop up with disease. For me that means you should absolutely keep an eye on the brain. If you have no known disease in the brain I would do an MRI scan at least every six months. If you do have known disease in the brain, even if it’s treated, I would be looking more frequently, possibly as frequently as one scanning the body on treatment, or maybe half as often.

Now if you do have disease in the brain, because the activity of crizotinib is not zero, unless you have a lot of symptoms from the disease in your brain, many people will start on the crizotinib, but obviously keeping a close eye because if you do progress in the brain, then you may have to salvage it.

You can salvage it in a number of different ways. One would tend to stay on the crizotinib and either have local radiotherapy or occasionally surgery depending on the site of the deposits in the brain. For me though, there’s a difference between one type of radiotherapy and another. For example, you can either treat the whole brain, what’s called whole brain radiotherapy, or you can treat individual lesions with what’s called stereotactic radiosurgery or SRS. I very much prefer giving SRS, even to a reasonably large number of lesions, than whole brain radiotherapy for the simple reason that people with ALK-positive disease are now living long enough that they’re manifesting the side effects of whole brain radiotherapy and that can mean word finding difficulties, memory difficulties.

So I think for me if you’re just at the point where you can spot weld a few areas with stereotactic radiosurgery, that’s fine — stay on the crizotinib. But if someone is thinking about whole brain radiotherapy, I would probably switch to a next generation ALK inhibitor rather than do the whole brain radiotherapy because we know they have good activity in the brain.


Ask Us, Q&A
Lung/Thoracic Cancer Expert Content

Archives

Share

GRACE Cancer Video Library - Lung Cancer Videos

 

2015_Immunotherapy_Forum_Videos

 

2015 Acquired Resistance in Lung Cancer Patient Forum Videos

Share

Join the GRACE Faculty

Breast Cancer Blog
Pancreatic Cancer Blog
Kidney Cancer Blog
Bladder Cancer Blog
Head/Neck Cancer Blog
Share

Subscribe to the GRACEcast Podcast on iTunes

Share

Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon

Subscribe to
GRACE Notes
   (Free Newsletter)

Other Resources

Share

ClinicalTrials.gov


Biomedical Learning Institute

peerview_institute_logo_243