Greetings to all. I am a newly diagnosed with stage 3B ALK+ Adenocarcinoma NSCLC. I am a 62 year-old female from the San Francisco Bay Area. Since learning I was ALK+ last week, I have gone from knowing nothing to being a "research sponge." One thing that I have searched for an answer to but can not find is whether anyone had had experience going straight to Crizotinib without radiation? The Radiologist( not clicking with this dude) is pushing for chemo radiation stating that I have a small but real chance of a "cure." My Medical Oncologist, who I really like seems to think that is somewhat overstated(approx 5%). Somehow I feel that I have "already "won the 3B lottery" being ALK+ and am definitely leaning away from the concurrent option. I have both accessibility issues at home and very bad GERD and fear chemo radiation side effects not worth the minute chance of the elusive cure.
I am schedule for a radiation"mapping" and will have to make a decision soon. I am somewhat symptomatic in the sense that I do have wheezing and coughing though I can still go about daily activities. Breathing at night is more problematic. However, I do not yet qualify of Oxygen at home. Any advice would be appreciated. I believe that getting on the right 1st drug(Crizotinib) as soon as possible makes sense but do I take a 6 week course of radiation or not?
Reply # - October 20, 2015, 06:29 AM
Hi msbab,
Hi msbab,
Welcome to GRACE. I am sorry to hear of your diagnosis but it is good that you are ALK+, which gives you the opportunity to use Crizotinib (Xalkori) as well as newer generation ALK inhibitors. As I'm sure you've discovered, there is much current research on treating ALK+ patients.
Stage IIIb lung cancer always presents treatment dilemmas such as the issues you raise. It is true that cure rates for Stage IIIb are low, although perhaps more like 10%. But these statistics don't take into account the ages, general health and comorbidities of those patients. Also, as Dr. West has said:
"patients with stage III NSCLC because of local extension tend to do better, with longer survival and better chance for cure, than patients who are stage III because of significant lymph node involvement. The latter predicts for a higher probability of distant spread to other parts of the body, which is, with rare exceptions, an incurable situation.
So it's quite true that the stats tell what happens to a population but don't necessarily paint an accurate picture of what will happen for an individual patient." - http://cancergrace.org/forums/index.php?topic=10156.msg81024#msg81024
Systemic treatments such as chemotherapy and targeted therapies have varied levels of efficacy from patient to patient. Some patients will achieve a complete response, with no evidence of disease visible, but most will see tumor shrinkage followed by stability. Although the response rate ALK+ NSCLC to Crizotinib is very good, not all patients respond well to it. Adding radiation can improve the chances of response, even if not to the point of cure.
Of course there are some patients for whom radiation is not appropriate, and your doctors are best equipped to help you make that judgment, and weigh the risks of radiation vs. the possibility of cure.
Good luck with the treatment path you pursue.
JimC
Forum moderator
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