When to go off Crizotinib? - 1264992

elizabetha
Posts:2

I've been on Crizotinib for 21 cycles and have done very well with virtually no side effects. My stage 4 ALK+ NSCLC initially shrunk and has been stable ever since per my CT scans. During this time, I experienced three fungal infections. The last one was treated with Fluconizol which required me to stop Crizotinib for 21 days due to the drug interaction.

There doesn't seems to be any information available about stopping Crizotinib without progression. I'm interested in understanding the risks of not taking Crizotinib while progression free. Can one go back on Crizotinib and expect it to work or maybe take it at a lower dosage?

Elizabeth

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Reply # - July 16, 2014, 09:19 AM

JimC
Posts: 2753

Hi Elizabeth,

Since your cancer is stable but has not disappeared completely, the assumption would be that Crizotinib (Xalkori) is keeping it under control. With that in mind, these comments from Dr. West may be helpful:

"The median duration of a response to XALKORI is about 10 months, but there are certainly some patients who can continue to respond for years. Because the drug has only been available for a few years, we don’t know the limits of what’s possible, but I think just about every expert believes that we aren’t curing metastatic NSCLC with XALKORI, even if we are able to provide excellent control, potentially for a time period extending into years. There is really no good study of cutting back on the dose, but I would say that there is a definite consensus that if the side effects are dangerous or intolerable, it’s appropriate to cut back to the point where it becomes safe and tolerable. However, I suspect that, based on very limited work out there, if the drug were put on hold or even cut to too low a dose, the cancer would progress again." - http://cancergrace.org/topic/xalkori-side-effects#post-1245127

In the same thread, he added:

"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."

JimC
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Reply # - July 16, 2014, 09:59 PM

Dr West
Posts: 4735

Jim found this information that is really exactly what I'd say today. Thanks, Jim -- I probably wouldn't have looked as hard or as effectively as you and would have just rewritten a very similar sentiment, perhaps not as clearly this time around...

Good luck, Elizabeth.

-Dr. West

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