Chemotherapy Choices for Alk driven NSCLC - 1259284

Sun, 09/15/2013 - 13:31

Hello:

I am new to this site but much appreciate ability to ask questions. My husband was diagnosed in Feb 2011 with Stage IV NSCLC at age 46-nonsmoker, healthy etc. After 6 cycles of Alimta two with Cisplatin. His cancer progressed. He only reached stability with Alimta. He had the Alk mutation and responded to xalkori (18 months) and CHUGAI (5months) with progression in liver and spine this August. Not knowing when LDK-378 will be available for Compassionate Use we are considering a few cycles of taxol.

Question- Have patients with Alk driven cancers responded to taxol with stability and or shrinkage for a period of time?

My husband also had a GI Bleed in 2009 from questionable NSAID use, but doctors never found where the bleed originatedfrom on further exam. He is back on motrin for pain once daily. Is it reasonable to consider adding Avastin to Taxol despite my husband\\\'s history? He is also completing radiation to low spine at this point. T5 and L2 area. Has had 10 treatments.

Husband 46 yold non smoker-Pleural effusion March 2010. Diagnosed Feb 2011 Stage Iv NSCLC. Cisplatin/Alimta march 2011-July 2011. Alk positive. Aug 2011-Feb -2013(progression to liver) CHUGAI March 2013-Aug 2013 (progression to spine liver) Radiation to spine Sept 2013 x10 treatments.

Warm Regards- What a service you do for people here!

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Dr West

Thanks very much for your kind comments, and I'm sorry your husband is dealing with progression now.

Various chemo agents can be helpful for ALK-positive advanced NSCLC. While there's a bit of data that says that ALK-positive NSCLC may be particularly responsive to Alimta (http://cancergrace.org/lung/2011/02/26/alimta-for-alk-rearrangment/), I would say that it is otherwise approached just like other advanced NSCLC and may respond to taxanes. Taxotere (docetaxel) is a more established option for patients previously treated with chemotherapy, but it's certainly reasonable to try Taxol (paclitaxel).

Good luck.

-Dr. West

catdander

Edit to say Dr. West has already responded but I'll leave as is.

Hi Jennifer and welcome to Grace. I'm very sorry your husband and you and the family are in this terrible cancer world. I will make sure one of our doctors responds to your post.

A few things you've mentioned are basic enough for me to direct you to excellent prior discussions.
Your question about likelihood of taxol being of benefit may be best addressed as how well your husband responded to chemo in the past. Dr. West stated here, " the two leading factors I’d consider are prior response to chemo in first line, and smoking status. To me, they both count pretty similarly. The main principles are that if someone responded well to chemo in first line, they’re more likely to respond well to second line chemo." http://cancergrace.org/lung/2008/01/24/selecting-2nd-line-nsclc-rx/ You're husband seems to have responded somewhat to alimta with stability.

I wonder where you got information about compassionate use of the LDK-378 drug. Usually a drug must go through more than just phase I trials before anyone would consider giving it outside a trial. Here is a link to 8 studies currently recruiting people for trials. Perhaps you are close enough to one of the sites to be considered a candidate. Also there is ongoing work to support those who need to travel to study sites. http://clinicaltrials.gov/ct2/results?term=LDK-378&Search=Search

Most specialists wouldn't consider Avastin to show enough efficacy to chance bleeding and possible death in someone who has had a history of bleeding problems.

I hope this gives you a place to start the thinking process. You will hear from a specialist in a bit.

Best hopes,
Janine

carrigallen

There really isn't any substantial evidence to suggest one chemotherapy is better than another for ALK+ patients. It is true that one center had proposed the idea that Alimta works better than Taxotere. However a large multi-center retrospective study identified an important confounder in this idea, which is common when dcotors make conclusions based upon small retrospective studies. My understanding is that the PROFILE 1007 trial with ALK+ patients did not show any statistically significant difference between Alimta and Taxotere (4.2 mo vs. 2.6 mo). So overall, it seems the total evidence does not support this idea. At best, it is inconclusive.