GRACE :: Lung Cancer

ALK

Denise Brock

ASCO 2017 – Lung Cancer – Sequencing Treatments for ALK+ Lung Cancer in a Crowded Field – Is there a place for Lorlatinib?

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H. Jack West, MD 

Medical Director 

Thoracic Oncology Program Swedish Cancer Institute

President & CEO, GRACE 

 

Matthew Gubens, MD

Thoracic Oncologist

Thoracic Surgery and Oncology Clinic of the UCSF Helen Diller Family Comprehensive Cancer Center

Jyoti D. Patel, MD

Director Thoracic Oncology

University of Chicago Medicine


Drs. H. Jack West, Medical Director of the Thoracic Oncology Program at Swedish Cancer Institute in Seattle, Washington and President and CEO of GRACE, Matthew Gubens, Thoracic Oncologist at the Thoracic Surgery and Oncology Clinic of the UCSF Helen Diller Family Comprehensive Center in San Francisco, California, and Jyoti Patel, Director of Thoracic Oncology at University of Chicago Medicine gathered post meeting to discuss new information from ASCO 2017 regarding lung cancer.   In this roundtable video, the doctors discuss  Sequencing Treatments for ALK+ Lung Cancer in a Crowded Field – Is there a place for Lorlatinib? 


 

 


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


GRACE would like to thank the following sponsors for their support of this program

  
                       

 


Denise Brock

ASCO 2017 – Lung Cancer – A Practice Change for ALK+ Lung Cancer Patients, Alecensa for First Line Treatment

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H. Jack West, MD 

Medical Director 

Thoracic Oncology Program Swedish Cancer Institute

President & CEO, GRACE 

 

Matthew Gubens, MD

Thoracic Oncologist

Thoracic Surgery and Oncology Clinic of the UCSF Helen Diller Family Comprehensive Cancer Center

Jyoti D. Patel, MD

Director Thoracic Oncology

University of Chicago Medicine


Drs. H. Jack West, Medical Director of the Thoracic Oncology Program at Swedish Cancer Institute in Seattle, Washington and President and CEO of GRACE, Matthew Gubens, Thoracic Oncologist at the Thoracic Surgery and Oncology Clinic of the UCSF Helen Diller Family Comprehensive Center in San Francisco, California, and Jyoti Patel, Director of Thoracic Oncology at University of Chicago Medicine gathered post meeting to discuss new information from ASCO 2017 regarding lung cancer.   In this roundtable video, the doctors discuss A Practice Change for ALK+ Lung Cancer Patients, Alecensa for First Line Treatment.


 

 

 


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


GRACE would like to thank the following sponsors for their support of this program

  
                       

 


Denise Brock

Lung Cancer Video Library – Spanish Language: Video #19 Second Line Therapy for NSCLC and ALK +

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GRACE Cancer Video Library - Lung

 

For our 19th 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 discusses second line therapy for non-small lung cell cancer patients with anaplastic lymphoma kinase (ALK) positive.


 

 

 

 


 

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TRANSCRIPTS – Spanish and English
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Terapia de segunda línea para pacientes con cáncer pulmonar de células no pequeñas y con la cinasa de linfoma anaplásico (CLA) positiva.

Para los pacientes que progresaron a crizotinib, en este momento hay dos fármacos: ceritinib que se puede considerar si el paciente progresa con crizotinib, y hay otro fármaco llamado alectinib que es la tercera línea para pacientes que progresan en terapia dirigida para ALK.

Lo que uno tiene que saber, es que, por la resistencia adquirida a uno de estos fármacos, uno tiene que checar la biopsia porque puede ser que el paciente no responda a estas terapias y necesite quimioterapia.


Second line therapy for non-small lung cell cancer and with anaplastic lymphoma kinase (CLA) positive

For patients that progressed to crizotinib, in this moment there are two drugs available: ceritinib that can be considered if the patient progresses with crizotinib and the other drug is alectinib which is a third line treatment for patients that progressed with ALK targeted treatment.

What we have to know is that, for acquired resistance to one of these drugs, one has to check the biopsy because the patient might not respond to these therapies and might need chemotherapy.


ExecDirCarlea

Three Reasons to Be Hopeful About Lung Cancer

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2016 Targeted Therapies Forum

The medical community has made significant progress in understanding that lung cancer is not a single cancer, and are treating it accordingly. We’ve stopped carpet bombing the body and have started using targeted weaponry to assassinate some forms of cancer. As a result, some patients are alive now, over a decade after being diagnosed with metastatic lung disease.

We can credit much of that progress to research into three specific mutations that drive distinctive forms of lung cancer. Instead of treating patients with these different mutations the same, we now give them individualized treatments that work differently based on their cancer’s mutation.

If you or someone you know is diagnosed with non-small cell lung cancer (NSCLC), there are three major subtypes the cancer should be tested for:

  1. ALK positive. A change in the cancer’s ALK gene allows the cancer cell to grow uncontrollably, but several drugs on the market have shown incredible responses and durations of disease control for patients. Even patients’ whose cancer has spread to the brain are now living years, not just weeks.
  2. ROS1 positive. A change in the cancer’s ROS1 gene, which is similar to the ALK gene, makes cancer cells grow and divide. Only one to two percent of lung cancer patients have it but with one highly effective drug on the market and several others being explored in clinical trials, even rare subtypes of cancers are focusing the attention of scientists, physicians, and the pharmaceutical industry alike.
  3. EGFR mutant. This was the first molecular marker that really showed a test done on lung cancer could predict who would respond to a specific targeted treatment. Now, our increased understanding of how the cancer can later evolve to grow in the presence of the first generation drugs has led to the development of next generation therapies which can regain cancer control in nearly 60% of cases, giving patients a second lease on life.

It is hard to overstate the awesomeness of these breakthroughs.

Around the world, a diagnosis of lung cancer leads to more cancer-related deaths than those from breast cancer, colorectal cancer, prostate cancer, and pancreas cancer combined. Yet for a growing number of distinct molecular subtypes of this disease, even advanced lung cancer can now be a controllable disease. Beyond the three subtypes described above, many other different mutations and genetic changes which could allow lung cancer therapy to be personalized are receiving testing in clinical trials. Most recently, the advent of immunotherapy – using drugs to stimulate the body’s own immune system to attack the lung cancer – has also shown promise, and how these two areas – personalized medicine and immunotherapy – will overlap and interact represent some of the major research directions for the future.

So, this is great news, right? Oncologists throughout the country are testing their patients’ tumors, and people are living longing and better than they could have ever imagined, yes?

No.

Despite all of this great news, many NSCLC patients do not get their tumors tested for ALK, ROS1, or EGFR mutations. Improving these numbers falls to the patients or their caregivers to educate themselves and advocate for molecular testing.

Fortunately, organizations like the Global Resource for Advancing Cancer Education (GRACE) exist solely to help patients become shared decision makers when it comes to their cancer care

GRACE is working with the University of Colorado Cancer Center in Aurora to hold a patient event on Aug. 20th for those living with ALK, ROS1, or EGFR mutant lung cancers. The organizers have already solicited questions in advance from patients in the internet lung cancer community.

The Targeted Therapies in Lung Cancer Patient Forum is open to patients and their caregivers. Renowned lung cancer experts from around the U.S. will present, and patients who are living with lung cancer will serve as moderators of the discussions that take place between the doctors and the audience.

The morning sessions will help attendees understand their mutation, learn of open clinical trials, and hear about treatment options;.all to help patients develop their plans A, B, C, and D. The afternoon will focus on survivorship in all its aspects, from finances to sex, to diet, to exercise – how to live life to the fullest with lung cancer.

Register today!

 


Dr West

Should Alecensa (Alectinib) be the new first line ALK inhibitor for ALK-positive NSCLC?

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Probably the most immediate potentially practice-changing presentation from ASCO was the Japanese J-ALEX study in the subset of about 4-5% of patients with non-small cell lung cancer (NSCLC) who have the molecular driver known as an anaplastic lymphoma kinase (ALK) rearrangement, which we now routinely test for from the tumor tissue of patients with a non-squamous metastatic NSCLC.   The current historical standard of care as first line treatment is Xalkori (crizotinib), which is an ALK inhibitor that happened to be readily available when the ALK rearrangement was first being studied in NSCLC about 5-7 years ago. Though it was granted an accelerated FDA approval back in 2011 based on early very promising activity and has since been confirmed to be superior to chemotherapy as first line treatment in ALK-positive patients, it is a less active ALK inhibitor than many other “second-generation” ALK inhibitors such as Zykadia (ceritinib) and Alecensa (alectinib), both now FDA-approved for patients who have developed progression after Xalkori or who are not able to tolerate it, as well as other agents still in development, including brigatinib (likely to become approved soon), and a few others further behind in development but also very active against ALK-positive NSCLC.

A question that logically follows is whether it is better to give one of these more active second generation ALK inhibitors as first line therapy, where they are likely to be more active for longer than if given for “acquired resistance” after Xalkori, or whether it’s better to start with Xalkori and have other powerful ALK inhibitors left for later.  Should we use our best drug up front or only the most effective drug required to do the job for now, saving something in the tank as we think more about advanced lung cancer as a distance race than a sprint? How much do we prioritize control now vs. options later?

There are several trials that have been initiated that all test a second generation ALK inhibitor vs. Xalkori.  Two of the first to be completed compare Alecensa to Xalkori, a large, global trial known as ALEX, and a smaller trial done in Japan only, known as J-ALEX, which reported early and remarkably interesting results at ASCO 2016.

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