Would Tarceva Work For ALK Mutation - 1250805

Tarceva (erlotinib) can be modestly beneficial in patients with an ALK rearrangement, but as a rule, almost no patients have both an ALK rearrangement and an EGFR mutation. In patients who don't have an EGFR mutation, the efficacy of Tarceva is generally not great, but it's not negligible either. Here's a link to some more discussion of this question.

http://cancergrace.org/lung/2010/09/21/benefit-from-egfr-tki-if-egfr-wt/

Good luck.

-Dr. West

Dr. West, would you prescribe to one of your patient's that had an ALK mutation and grew resistance to Xalkori? Take care, Judy

It wouldn't be my top priority (i.e., I'd favor chemo first, if the patient had progressed on first line XALKORI), but yes, I'd offer it later, based on the limited amount we know now about what to expect.

-Dr. West

Would insurance now cover it if you don't have the mutation? Just curious how this is all progressing, since it's fairly new. Take care, Judy

I just wanted to say to Rizal - there is some evidence that people with the ALK respond well to Alimta (pemetrexed):
http://cancergrace.org/lung/2011/02/26/alimta-for-alk-rearrangment/
- although I don't think the scientists have quite worked out whether the good response to Alimta is related to a) having the ALK or b) having a non-smoking history:
http://cancergrace.org/topic/alimta-sensitivity-correlates-with-never-o…
Nonetheless, it might be useful information. Very best.

In the US at least, Tarceva (erlotinib) would be covered by most insurers, since it's FDA approved for chemo-pretreated patients with advanced NSCLC, regardless of molecular marker results.

-Dr. West

Thanks Dr. West, that's good to know. I think some patients fear they'd have to pay out of pocket if they don't have the mutation. Take care, Judy

The problem people in the US have with insurers is tarceva and possibly xalkori is covered under their prescription plan which is usually quite different than the medical plan that covers chemo.

I'd hoped that would have been addressed by now.

I don't think that has been addressed yet just from recent posts I've read. Which I know makes it very costly. Take care Judy

If you've read of anyone having trouble paying in the US, that's probably the problem. It's not more expensive than the combined cost of receiving chemo infusions at a cancer center, it's just billed differently. At least when D took it Feb to Nov 2010. We were able to access assistance from the makers until the prescription out of pocket limit took affect on D's individual blue cross prescription insurance.

I hope it's addressed by the insurance companies, that is.

I know that Medicare and most insurance companies consider it under a prescription plan. There are some states that require the insurance companies to pay as if it were a chemo drug, but not all. Medicare would cover it under prescription drug plan. Thankful for those who get assistance from the drug manufactuers.
Take care, Judy