Gammaknife-discontinuance of zalkori for surrounding days

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This topic contains 3 replies, has 3 voices, and was last updated by  aliciauk 3 years, 8 months ago.

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March 28, 2014 at 4:33 am  #1262984    

aliciauk

Hi there

I am having gamma knife in 10 days for two tiny brain mets, saw my oncologist yesterday and she suggested coming off crizotinib for a couple of days before and after the Gammaknife, she said the discontinuance was precautionary and there was no evidence about it. I wondered what views other oncologists /neurosurgeons had about this, Is there any risk of a flare or the cancer having an opportunity to become more aggressive if I am off zalkori for five days or is a gap of this duration of no concern? tThank you Alicia

March 28, 2014 at 5:35 am  #1262986    
JimC Forum Moderator
JimC Forum Moderator

Hi Alicia,

In the context of a Xalkori treatment break necessitated by difficulties with side effects from the drug, Dr. West has said:

“I don’t hesitate to offer a break for people with good control. There is some risk of a “flare” of rapid progression — sometimes the cancer can rebound and progress readily after a few weeks off of it if a significant amount of tumor burden is has been effectively suppressed by the targeted therapy and suddenly isn’t. But if my patient needs a break, for whatever reason, I just have them be ready to restart it in the event that they develop rapid worsening of cancer-related symptoms. Otherwise, they can enjoy a break from the side effects and will often do just fine.” -http://cancergrace.org/topic/xalkori-side-effects#post-1245155

A few days is unlikely to be a problem.

Good luck with the Gamma Knife.

JimC
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: http://cancergrace.org/blog/jim-and-lisa

March 28, 2014 at 6:31 pm  #1262995    
Dr West
Dr West

I would say in a situation in which there is no data, you’ll see some doctors doing just about everything, but I think the majority would favor holding XALKORI (crizotinib) during brain radiation, even if it’s over a few weeks, let alone just a one-day treatment like stereotactic radiosurgery (SRS, also sometimes known as Gamma Knife or Cyber Knife). With SRS, it’s a very high dose all at once, so the potential harmful effect of a negative interaction is great, and the time off is very minimal. I am very much inclined to favor a break of at least a day or two before and after SRS, and I think the risk from that break is exceptionally small. One point to make is that XALKORI doesn’t get into the brain very effectively, so the risk of overlapping side effects are likely very small, but it’s so unstudied and the potential of making a bad assumption so great that I do not see any remote reason to have the treatments overlap.

-Dr. West

March 29, 2014 at 3:19 pm  #1262998    

aliciauk

Thank you Jim and Dr West. Alicia.

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