Chemo then Target Therapy? - 1273586

I don't think there is any evidence to suggest that chemotherapy should be preferred or favored over crizotinib for ROS1+ patients. Usually if a drug has a high chance of working with fewer side effects, we will favor the targeted drug.
There is theoretical evidence that chemotherapy creates selection pressure on tumor cells to create more subclonal resistance mutations. This process could adversely affect the chances of a long term remission with crizotinib. So I would vote to use crizotinib first, if possible.

Hi fanos,

Although there may be a sequential benefit from using crizotinib and chemotherapy, the evidence shows that patients achieve longer disease control by starting with crizotinib rather than chemo. In addition, when a patient develops acquired resistance to crizotinib, many oncologists will probably switch to a second-generation ALK inhibitor such as ceritinib, which is expected to be effective for ROS1 patients. If needed, chemotherapy remains an option after these choices have been exhausted.

Dr. Camidge discusses the question of whether to start with chemo or crizotinib in this recent podcast. Although the chemo regimen to which Dr. Camidge refers is a platinum doublet, such as carboplatin/paclitaxel, the evidence for benefit from the addition of bevacizumab (Avastin) is much less persuasive than originally thought, and many oncologists do not add it to their patients' platinum doublets. Dr. West discusses that issue in a podcast to be released in the next few days.

It's good to remember, though, that results from trials reflect the experience of large numbers of patients rather than a single patient. An individual patient may have better (or worse) results than the medians reported from those studies.

JimC
Forum moderator