Start alectinib when only Lymph Node metastisis??

Portal Forums Lung/Thoracic Cancer ALK Inhibitors Start alectinib when only Lymph Node metastisis??

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February 26, 2018 at 10:51 pm  #1294018    

me53

I had potentially curative surgery that didn’t work; doctor missed some lymph nodes and one had cancer cells in it. One year out, cancer in all lymph nodes remaining (left and right) mediastinal; no distal metastasis yet. I read that alectinib for many people works only 1 year or less (4 months, 5 months eg), while for some 2-3+. No crystal ball, but if I use up my alectinib before I REALLY need it (major organs, multiple tumors/organs there) was that a wise choice.. Is it considered best to potentially use up whatever time alectinib would give you when only mediastinal lymph nodes or to wait, as I would have done if he’d removed all lymph nodes on that side, until distal organ metastasis. Of course risk of liver tumor carries with it unable to process med due to hepatotoxicity and less organ fit to process it. Because all LNs, and because radiation such risks iwth it and unpleasantness (to put it mildly) and fact can’t really use it much later in body if use so much now, I don’t feel inclined to use. Thoughts???

February 27, 2018 at 6:46 am  #1294021    
JimC Forum Moderator
JimC Forum Moderator

Hi me53,

No clear cut “right” answer, but a few points to consider. First, it’s good to remember that the one-year figure for alectinib is a median, with half of the patients achieving a longer benefit. Also, though i can’t point to specific data, it makes sense that at least to a point, the higher the tumor burden, the sooner one might expect resistance to occur (a greater number of cancer cells having the potential to mutate further).

With that in mind, factors in favor of starting now include the opportunity to possibly knock out all remaining cancer cells. Perhaps not a high percentage chance, but not zero. In addition, the pace of lung cancer research has never been as fast as it is now, so the longer you keep yours under control, the more time researchers have to find new agents which you could use down the road. If I read your post correctly, the number of lymph nodes involved has increased in the past year, so there is some evidence of progression, so it would be good to get that under control.

On the other side of the argument is the factor you mentioned, using up a good treatment early, plus the toxicity of the treatment itself.

Radiation is often used when there are only a couple remaining metastases, but it’s not as attractive an option when there are multiple sites.

Good luck with whichever path you choose.

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

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