jays
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Posts:2
Hi,
A 56 year old woman with ALK positive, stage IIIa adenocarcinoma of lung with bulky mediastinal nodes has been treated with Crizotinib for the past 6 months. She had an good response at 3 months in terms of the right upper lung mass and nodes but the latest PET scan at 6 months shows increasing size and activity, still only on the right side. A single brain leison which was initially 0.7 cm has now increased in size to 1.2 cm. No symptoms of any kind. She has been switched to Alectinib.
The question is: Can the brain met be observed for response to Alectinib alone or should radiosurgery be considered? Also, is this more properly called stage IV or is there such a thing as stage IIIa with single brain met?
Thank you for your help.
Forums
Reply # - July 6, 2016, 03:56 PM
Hi jays,
Hi jays,
Welcome to GRACE. I'm sorry to hear about the brain met. Since it's asymptomatic, and Alectinib has been shown to have activity in the brain, it's certainly possible to delay using radiotherapy to see if Alectinib can successfully teat it. If so, the patient would need to be followed very closely, with a follow-up scan at a fairly short interval and any suspicious symptoms reported to the medical team in a timely manner.
Unfortunately, the appearance of a distant metastasis such as a brain met indicates that cancer cells have entered the bloodstream, making this stage IV.
Good luck with Alectinib.
JimC
Forum moderator
Reply # - July 6, 2016, 04:04 PM
Dr. Pennell had this to say
Dr. Pennell had this to say about Alectinib and follow-up for brain mets:
"Most patients with known brain metastases get surveillance MRI scans periodically, and it appears you are on a 3 month interval which is very common. It is generally a good idea to keep on a somewhat regular schedule so you don’t miss changes that can be addressed with a change in treatment or perhaps radiation, but the exact time of 3 months isn’t that critical.
No one knows the best time to look for response to a drug like alectinib, but most clinical trials use 6 or 8 week intervals for scans to keep the endpoints like “progression free survival” the same between trials and so in practice we end up copying this. In reality though, drugs like alectinib can start to work within days, and often responses can be seen within a week or two. I think an MRI 5 weeks after starting alectinib has a good chance of accurately reflecting whether the tumors are going to respond, but if they were stable they could certainly still shrink on the next scan. I don’t think waiting longer is likely make much of a difference since both stable and shrinking are good." - http://cancergrace.org/topic/how-soon-after-starting-alectinib-should-b…
Note that this comment was in response to a patient whose brain mets had been stable. Since the brain met you describe had been growing, the patient would probably want a follow-up scan a bit sooner.
JimC
Forum moderator
Reply # - July 6, 2016, 07:14 PM
JimC,
JimC,
Thanks for the quick reply.
Jays