Hx: 6.5 yrs ago hemorrhagic brain met with acute surgical resection, NSLC, ALK +, Initial induction Platinum/pemetrexed with outstanding response. Got WBR. Brain mets gone, lung nodes gone. lung primary shrunk. Maintained on Pemetrexed alone for 1 ½ years without progression until renal damage and all chemo stopped without progression for almost 1 ½ more years. Then primary progressed slowly, Crizotinib started with great results >50% reduction without change for 2 years. Recent MRI shows 3 small new brain mets, 2mm and 4mm in cerebellum and 4 mm in frontal area opp. side from initial lesions without edema. Only current sx are balance issues. PET/CT shows no active disease in body, including the primary.
Issue are options: Use Chemo alone (alectinib recommended vs ceratinib) and wait on radiation vs use stereotactic along with alectinib since lesions are quite small.
To me, given excellent past response, would go with alectinib and stereotactic together. Wondering about other opinions including proton beam, other med possibilities, clinical trials with new agents.
Reply # - February 19, 2017, 04:34 PM
Hi kiddoctor,
Hi kiddoctor,
Congrats on being a good responder, it bodes well for future treatments. The standard of care, what's proved to be the next best thing would be alectinib for systemic treatment and stereotactic for brain mets. There are several people in the online community who have taken this drug for more than a year or even 3 or 4. There's much hope for it's efficacy. Sometimes if brain mets are asymptomatic radiation is held to give alectinib a chance to work in the brain as it's shown to sometimes do; providing the person with time before any radiation is needed. Most often alectinib would be held during radiation since stereotactic is just a few treatments there's usually no worry about the short break from alectinib. The problem is side effects can get toxic when combined.
I hope you do well moving forward.
All best,
Janine