New Brain mets, recommend radiate.Too soon?Just had brain SRT 5 months ago. ALK+

Portal Forums Radiation Oncology Brain Metastases / PCI New Brain mets, recommend radiate.Too soon?Just had brain SRT 5 months ago. ALK+

This topic contains 7 replies, has 5 voices, and was last updated by  southsidegirl69 1 year, 8 months ago.

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March 23, 2016 at 9:44 pm  #1273372    

southsidegirl69

Hello,
I am feeling pressured by radiologist to have brain radiation next week. In Sept. 2015, 3 small brain mets were discovered and I had SRT/ Radiation to treat them in October 2015. This week, a follow up brain MRI shows 2 new mets, one of which is a 2.7cm subacute hematoma*, right temporal lobe, the other a 2 mm lesion left cerebellar region. My radiologist is advising that I have these 2 new mets radiated next week. In between these two brain mets “events”, I had a lung nodule radiated, with the radiation treatments recently ending: mid-January 2016. I had been on crizotinib for 16 months, went off for the month of January 2016 during lung radiation, and now my Onc.has me back on crizotinib.
My questions are, with just having brain radiation 5 months ago in Oct. 2015, and lung radiation recently ending 8 weeks ago, January 2016, is it of utmost urgency to have these 2 new brain mets radiated next week? I am not presently experiencing symptoms of any sort relating to the brain mets, no dizziness, headaches, etc.
My second concern is that crizotinib is not doing much to keep the brain mets away, yet my onc is still keeping me on the criztotinib. So my second question is, would one of the newer tki, (tyrosene kinase inhibitor) drugs be more effective with slowing or reducing the brain mets, since the brain mets are continuing to appear, (and I assume, will continue) and the only solution that my health team recommends seems to be be radiation? I have watched the many relevant videos addressing this 2nd line treatment matter.
Thank You.
*(“likely on the order of several weeks to 2 months old”)
On Crizotinib for 16 months before the original brain mets appeared on MRI IN Sept. 2015.
I have a 2.7cm lung nodule, which was treated recently-radiated ending January 2016.=Waiting to see. ALK+ (3 a/b), and TP53 positive;back on criz. after lung radiation, to present.
Never smoker, Healthy white female, age 59

March 24, 2016 at 6:51 am  #1273379    
JimC Forum Moderator
JimC Forum Moderator

Hi southsidegirl,

Although your brain mets are not currently causing symptoms, that larger of the two is not insignificant in size, and if left untreated may continue to grow to the point of becoming symptomatic.Your doctor’s thought process, shared by many oncologists, is that if a targeted therapy is keeping the cancer in the remainder of the body essentially stable, then a couple of brain mets or distant mets may be radiated and the targeted therapy continued. Dr. Weiss has a podcast on this subject.

Of course, if the current targeted therapy is not controlling the cancer outside the brain, then moving to a next-generation inhibitor may make sense. Although some of these drugs have been touted as having good CNS penetration, the evidence is mostly anecdotal so far.

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 25, 2016 at 8:26 am  #1273392    

cards7up

If this is a hematoma, that’s a bleed in the brain or blood accumulating there. Did they mention that? That would tend to make it more serious and in need of treatment ASAP. The good news is that they’re still suggesting targeted radiation and not whole brain radiation. Here’s a link to a great article about Xalkori and brain mets. Wishing you the best. Take care, Judy

http://www.cancertherapyadvisor.com/lung-cancer/non-small-cell-lung-cancer-crizotinib-alk-brain-metastases/article/400453/

I am not a medical professional. I am a two time Lung Cancer Survivor since 2010.


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

March 25, 2016 at 12:48 pm  #1273399    
catdander forum moderator
catdander forum moderator

Thanks Judy! It always good to have your input.

March 26, 2016 at 7:22 am  #1273400    

southsidegirl69

Thank you, JimC and Judy for your replies and informative links. Judy, I am elated to hear that you are a two time lung cancer survivor!! Yes, it is good news that they are not recommending whole brain radiation.
My oncologist is keeping me on crizotinib for my ALK+ lung cancer. I am experiencing development of new brain lesions. I can relate to the article in the above link: ‘progression of pre-existing brain lesions and development of new lesions continued during crizotinib therapy. As new therapies extend survival of NSCLC patients, brain metastases are likely to become a common clinical challenge.” As JimC noted previously, it seems that it would make sense to move to a 2nd generation inhibitor which provides some brain protection.

I received targeted radiation treatment to 3 first-time brain mets Oct.’15. Now, just 5 months later, there are 2 new mets, one of which had bled.
It is this hematoma that is concerning me.. It was noted on the radiology report as
“likely on the order of several weeks to 2 months old”. The radiology oncologist did not answer the question I had as to whether it would be dangerous to radiate a hematoma. They want me to come in next week for SRT on the 2 brain lesions. I feel like I need an answer before having radiation to that hematoma.I could not find any posts from anyone who had a brain hematoma radiated, nor podcast.

Would it be dangerous to radiate a hematoma? Would it cause more bleeding, possible stroke?

Thank you.

March 26, 2016 at 3:05 pm  #1273403    

cards7up

I’m afraid that is something I’d want a neurologist to be answering before radiation. Have you seen one yet?
I don’t know how they treat brain hematomas. If it’s a subdural hematoma, that is outside the brain. Do they know what’s causing the bleed? Where are you being treated? Take care, Judy


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

March 26, 2016 at 4:56 pm  #1273404    

Dr. Ben Creelan

Generally, switching to alectinib is ideal for situations like this. Alectinib has excellent blood-brain penetration and it is FDA approved for this situation.

I don’t believe in repeating the same thing over and over, expecting different results. It seems unlikely that repetitive courses of stereotactic radiation will result in a durable remission for this kind of situation. It may end up making your local radiation clinic happy, but little else. I also find that patients have long term problems with multiple courses of stereotactic RT, like radionecrosis.

There are also clinical trials available, for example the international STARTRK2 trial has a cohort open for patients with brain mets.

March 27, 2016 at 7:16 pm  #1273418    

southsidegirl69

Thank you so much for your valuable input, Dr. Creelan. I am going to meet with my Oncologist early this week and present my concerns, and the ideas regarding switching to a different drug and the clinical trial.

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