waikay2002
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I was diagnosed with NSCLC lung adenocarcinoma last year and had lobectomy to remove RUL. Molecular testing shows ROS1 mutation. Is ROS1 mutation not suitable for immunotherapy? I also heard that Cimavax can be a good agent for high risk lung cancer survivor who had lung cancer before to prevent recurrence. Is that true? Thank you. Rick
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Reply # - April 18, 2018, 01:51 PM
Hi,
Hi,
The evidence so far tends to indicate that patients with a ROS1 mutation tend not to respond well to current immunotherapy agents, as Dr. West discussed here: http://cancergrace.org/lung/2016/10/22/io-wrong-for-egfr-mut/
Cimavax is a relatively new treatment developed in Cuba, where it has shown promising results in early-phase clinical trials. But it's too soon to know how effective it will be for lung cancer patients in general or ROS1 patients in particular.
JimC
Forum moderator
Reply # - April 18, 2018, 03:06 PM
I don't think we can say for
I don't think we can say for sure what impact can be expected from cimavax. (unless there is news from the cancer research convention). But there are trials underway to get answers that tcan direct treatment decisions.
xalkori is still the best option for ros1 patients with excellent response rates.
"ROS1 fusions in NSCLC respond very well to targeted therapy with Crizotinib (Xalkori). The U.S. Food and Drug Administration (FDA) recently approved Crizotinib for the first line treatment of ROS1-rearranged metastatic NSCLC. ROS1 fusions in most cancers other than lung cancer are treated with chemotherapy. There are currently several targeted treatments under evaluation for the treatment of ROS1-fusion positive patients, either in the first-line setting or after resistance to crizotinib sets in."
https://www.lungcancerfoundation.org/patients/ros1/about/
Reply # - April 18, 2018, 04:37 PM
As per Janine, Xalkori is the
As per Janine, Xalkori is the recommended first line treatment (standard of care) for lung cancer with ROS1. After Xalkori stops working there are clinical trials to consider or the other option is chemotherapy. I did a search at clinicaltrials.gov specifically for ROS1 in lung cancer. There are 3 studies in the database looking at Ceritinib, Lorlatinib and Cabozantinib, respectively. These are all TKI or ALK inhibitors.
1
Not yet recruiting A Study of LDK378 in Patients With Non-small Cell Lung Cancer Harboring ROS1 Rearrangement
Non-small Cell Lung Cancer Harboring ROS1 Rearrangement
Drug: LDK378(Ceritinib)
2
Recruiting A Study of Lorlatinib in Advanced ALK and ROS1 Rearranged Lung Cancer With CNS Metastasis in the Absence of Measurable Extracranial Lesions
Non-Small Cell Lung Cancer (NSCLC)
Drug: Lorlatinib
Massachusetts general Hospital
Boston, Massachusetts, United States
3
Recruiting Cabozantinib in Patients With RET Fusion-Positive Advanced Non-Small Cell Lung Cancer and Those With Other Genotypes: ROS1 or NTRK Fusions or Increased MET or AXL Activity
Non-Small Cell Lung Cancer
Drug: Cabozantinib
There are other studies listed on a link in the page Janine posted that look not just at lung cancer but 'solid tumors' here: https://www.lungcancerfoundation.org/patients/ros1/trials-and-treatment…
Reply # - April 19, 2018, 07:40 AM
One issue that we haven't
One issue that we haven't addressed is the staging of your lung cancer. For early-stage cancer, post-surgery (adjuvant) systemic therapy is usually not recommended, as the risks do not justify the potential benefit of treating a cancer that may have been cured with surgery. Dr. Sanborn discussed the use of adjuvant therapy in early-stage lung cancer here, as did Dr. Wakelee here.
JimC
Forum moderator
Reply # - April 19, 2018, 08:04 AM
I realize this is not exactly
I realize this is not exactly the situation your father is in but the results are relevant to our discussion of this complicated situation that patients are trying to solve for themselves. I think the publically available Lancet paper below
"Carboplatin and pemetrexed with or without
pembrolizumab for advanced, non-squamous non-small-cell
lung cancer: a randomised, phase 2 cohort of the open-label
KEYNOTE-021 study"
is relevant. You can read it here: http://wp.vcu.edu/hemeoncfellowship/wp-content/uploads/sites/3982/2017/…
I found this by first searching news in regular google and then finding a subset of search words to search in scholar.google.com
I don't know to what extent this information is searchable in Chinese. The Engish I settled on was "Pembrolizumab & Pemetrexed maintenance therapy" typed into google scholar.
Hope this helps.
Edited to add: The first search I started with took me directly to a cancergrace.org site. It was a tape without a transcription so I searched further below till I found something relevant and clicked on that: etc...
So the good news is that cancergrace is coming out on the top of google search. I would just add to try to include a collection of relevant search terms in each post so that information appears as a 'unit' in google