EGFR and ALK positive

Portal Forums Lung/Thoracic Cancer NSCLC Stage IV NSCLC EGFR and ALK positive

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December 21, 2017 at 12:52 am  #1293666    



My dad has been diagnosed with NSCLC adenocarcinoma that is EGFR 19 deletion and ALK positive. I understand that this is an extremely rare case to have 2 mutations and I am wondering if this were the case, whether we should be treating for these 2 mutations concurrently? He is currently taking Iressa and our onco has suggested to continue with Iressa for the time being.

I am feeling a little concern about not treating for ALK as well, in fear that just taking Iressa would only treat the EGFR mutation which may then allow the ALK to continue to progress.

Could you please advice as to what we should be doing?


December 21, 2017 at 6:18 am  #1293667    
JimC Forum Moderator
JimC Forum Moderator

Hi schwanza,

Welcome to GRACE. I’m sorry to hear of your dad’s diagnosis, but it’s positive news that he has actionable mutations that can be attacked with targeted therapies.

GRACE’s Dr. Pennell had this to say about having both mutations:

“generally we think of the “driver mutations” (that drive the cancer to grow) such as EGFR mutations, KRAS mutations, or ALK translocations as being mutually exclusive. In some rare cases they are found together, but in that setting typically only one is dominant and confers sensitivity to a drug like Tarceva or crizotinib.” –

So it may be that significantly more cells showed the EGFR mutation than the ALK rearrangement, which would explain his doctor’s preference for the EGFR inhibitor. Even if that’s not the case, typically the EGFR and ALK inhibitors are not combined, and since he’s likely to be closely monitored with follow-up scans and clinical examinations, if the EGFR inhibitor does not seem to be working and there is noticeable, significant progression, he can switch to an ALK inhibitor. Many patients and caregivers quite understandably have a desire to discover the smallest amount of progression as soon as possible and then switch treatments, but that is usually neither necessary nor does a rapid change in therapy tend to provide the best results.

Good luck with Iressa, and please let us know how he’s doing, and be sure to post any other questions that arise.

Forum moderator

Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then:

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