Does New brain met = Acquired Resistance To 2nd line Alectinib (Alecensa)?

Portal Forums Lung/Thoracic Cancer ALK Inhibitors Does New brain met = Acquired Resistance To 2nd line Alectinib (Alecensa)?

This topic contains 2 replies, has 2 voices, and was last updated by  lessie 1 month ago.

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October 16, 2017 at 11:05 am  #1293335    


Hello, I am approaching my 4 year Survivor anniversary in January 2018,( Stage 4 lung cancer with liver, spine lymph mets! ALK +). After chemo then crizotinib, stable. Started Alectinib April 2016 due to acquired Resistance to crizotinib. The initial dose of 1200 mg/day of Alectinib was super toxic. So after much dose reduction and labwork, went down to 450 mg/ Alectinib per day for past year. Stayed stable. Well, brain MRI last week shows new brain met, 7.3 mm. Left cerebellum. Primary lung tumor stable 1.8 x 2.1 cm. A New enlarged 1 cm. prevascular heart area lymph node discovered on June CT scan was stable on September scan, but still “new”. So, the question is: when patient is on 2nd line tki therapy then develops brain mets and lymph node enlargement, is that considered acquired resistance to the 2nd line drug? I viewed the entire Patient Forum on Targeted Therapies videos presented at Cleveland Clinic. My Radiation oncologist wants to stereotactic radiate the brain met. This will be the 3rd time for brain radiation, twice previously I have had SBRT to other brain mets. [1st time 4 mets, 2nd time 1 met, now this one. Am wondering how many more times I’m going to have to be having brain radiation as the remedy as I live with these ongoing emerging brain mets.] I am going to request from my onc. a rebiopsy to see what new resistant mutations may be present to guide new 3rd line drug if that’s what he decides would be the best next step. Didn’t remember any of the doctors on the video mentioning to go ahead and stay on the Alectinib if brain mets and lymph nodes develop. Thank you. By the way, also a BIG THANK YOU for hosting the Patient conference and posting the entire video, so helpful and informative. This GRACE forum is so important and valuable.

October 16, 2017 at 2:03 pm  #1293336    
catdander forum moderator
catdander forum moderator

Hi Lessie,

Welcome to Grace and Congratulations for doing so well.

We can’t be certain that alectinib is responsible for the lack of brain mets. Likewise you can’t be sure brain mets are caused by acquired resistance if you’ve not had brain mets that responded to alectinib. The only real way to know a systemic anti cancer drug worked in the brain is to have had a brain met respond to it. (get smaller with only alectinib).

If the lymph node enlargement is due to cancer then it’s easier to point to acquired resistance. So while it’s suspicious of resistance it’s not conclusive.

Even though an enlarged lymph node in the presence of cancer is more likely to be cancer it’s still possible the lymph node is infection or other inflammatory process unrelated to cancer. There are many reasons why not to give up on alactinib just yet.

Acquired resistance is looked at on a wide spectrum. It doesn’t necessarily mean you need to change treatments. I imagine you’re familiar with using focal radiation to one or two places of progression if other sites remain stable. That’s what it sounds like your oncologist is suggesting for the brain met. This is done because often people develop acquired resistance in just one or 2 places while the rest of the body remains sensitive to the drug. Getting rid of the resisted nodules offers more time on the drug for months to years to many people.

It’s not unusual to have several brain mets radiated with SBRT. People have really pushed this envelope with 10 and 15 mets with success but 3 is still a very reasonable number.

I hope you continue to do well on alactinib for a long time.
All best,

October 16, 2017 at 5:13 pm  #1293339    


Thank you, Janine. I feel encouraged and hopeful by your words: “getting rid of the resisted nodules offers more time on the drug for months to years to many people.” Maybe I will have the good fortune to be one of those people. (When I read about your husband’ s journey and success, I was thrilled and overjoyed! Best wishes for his continued health, and kudos to his “bulldog”!)

Thank you also to Dr. West and all of the moderators and doctors who provide this wonderful resource.

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