Switching from Xalkori due to brain mets - 1257866

tjames
Posts:22

I have been on Xalkori for almost 9 months and it is still "working". However, I have had a total of nine very tiny "mets" that I have had treated by the gamma knife. Assuming that my next MRI, which I will have next week, indicates additional mets in the brain, should I consider switching from Xalkori to some other ALK inhibitor that may be more effective in passing the blood/brain barrier in order to prevent additional mets in the brain. While I would not like to drop Xalkori while it may have many more months of potential effectiveness, I am thinking that perhaps that might be the way to go if something lie LDK or Chugai would be more helpful to the brain. Of course, that assumes that I could be admitted to one of the pending clinical trials. Any thoughts would be appreciated.

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Reply # - July 12, 2013, 07:38 PM

Dr West
Posts: 4735

It's a judgment call, and I'm afraid that really falls in the range of medical advice, which we aren't permitted to give. There's certainly no clear or evidence-based answer to this question. It's possible to treat new mets with radiation, and I think an important question should be whether to do whole brain radiation if there are multiple new brain metastases. Doing stereotactic radiosurgery to more than even 3 is a questionable practice, since the more brain mets you find, the more likely there are other ones. It's very possible that whole brain radiation plus crizotinib could be an effective combination.

Meanwhile, all we can say about the second generation ALK inhibitors and brain metastases is that some responses of brain metastases have been seen in a few patients, but I think it's appropriate to be cautious about making changes in treatment based on results of any conclusion drawn from a number of patients you could comfortably count on the fingers of one hand.

Finally, I'd consider this a more pressing problem if new metastases are seen right away, and less of a real imperative to change anything if new brain metastases are detected, but only after a year or more after the prior ones are treated. The longer the progression-free interval, the less inclined I tend to be to make significant changes.

Good luck.

-Dr. West

Reply # - July 14, 2013, 11:17 AM

catdander
Posts:

Dr. West,
I'm confused by the wording in your 1st pp and wonder if the term radiosurgery or gamma knife should be used instead of radiation or wbr in the first couple of sentences. It's very true I may be lacking in knowledge in the area which may explain my confusion.

Janine

Reply # - July 14, 2013, 03:13 PM

Dr West
Posts: 4735

Janine,

Of course you're correct, and thank you for catching my error, which I edited. Jim has found many of these, and I'm happy to know of them. Don't hesitate to correct them yourself or let me know here or via e-mail. This won't be the last time.

-Dr. West

Reply # - July 22, 2013, 01:06 PM

tjames
Posts: 22

As a follow-up to my initial post,My MRI showed no new mets and the older mets that were treated by the gamma knife are either shrinking or no bigger. My doctor is extremely pleased with those results.My happiness with these results is of course tempered by the knowledge that things could change in the future, but so far so good for now.

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