Mucinous BAC - Options - 1263970

I actually didn't say that if a cancer responds to Alimta (pemetrexed) that it is likely to be ALK+. There is a very limited amount of suggestive evidence that patients with an ALK+ NSCLC seem to often respond well to Alimta, but the response rate to a platinum/Alimta combination is about 25-35%, and only about 4-5% of NSCLC patients in North America and many other places have an ALK rearrangement, so I would not presume that someone who responded to a platinum/Alimta combination must therefore have an ALK rearrangement. I do favor testing adenocarcinomas, including BAC, for an EGFR mutation or ALK rearrangement. XALKORI (crizotinib) would be an excellent treatment plan if an ALK rearrangement is detected, but not otherwise.

Here's further discussion of the issue:

http://cancergrace.org/lung/2011/11/29/bac-today/

Good luck.

-Dr. West

Sameer, I'm sorry your mom is in this situation.
I think you may have misunderstood about the connection between ALK + and alimta. Many people with adeno nsclc do well on alimta whether they are positive for the ALK rearrangement or not. In addition those who are ALK + have adeno nsclc. So the correlation may be that they have adeno not that they are ALK +. We don't know which but there might be a correlation between alimta and ALK there would need to be more data to know.

However it is fair to see if your mom can get tested for ALK rearrangement because there are drugs that are effective for ALK only and if your mom is positive the drugs could be helpful.

Other than that there are chemo drugs that could be helpful. Below is a link to info on 2nd, 3rd etc line treatment. Note there are more links at the end of the discussion. http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…

This is a link to several blog posts on mucinous BAC, http://cancergrace.org/search-results?q=mucinous%20BAC

I hope this is helpful,
Janine

That's not really true about chemo agents like alimta when a person progressed on it. Dr. West said, “We might sometimes return to a chemo on which someone had a response and then had it discontinued because they reached a fixed amount of treatment, but we don’t generally return to a chemo treatment on which a person progressed.” – http://cancergrace.org/topic/revisiting-former-chemo#post-1248780
And Dr. Pinder agreed:

“Whether or not I would have a patient go back to a previously effective regimen depends on why the regimen was stopped. Now that I have some patients on 5th/6th line therapy, I find that I am sometimes going back to previously effective regimens that were stopped to give a patient a treatment break. When a treatment was stopped for progression I do not go back to it.” – http://cancergrace.org/forums/index.php?topic=2123.msg12629#msg12629

There are 3 drugs that have been tested as 2nd line treatment and proven to lengthen longevity; alimta, taxotere, and tarceva (erlotinib). Since your mother progressed on a combo of alimta and Gefitinib neither alimta or gefitinib would be considered good choices. Gefitinib and erlotinib are very close in makeup and there have been smaller studies that suggest tarceva may still have efficacy after progression on gefitinib.
That leaves taxotere as probably the best choice of trial studied drugs.
There are other drugs that have shown to have efficacy in first line nsclc (including BAC) they include gemcitabine (gemzar) and navelbine. Here is an indeapth discussion on the subject, http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…

I hope this helps shed light on the subject,
Janine

Thanks to Janine for the explanation and the link to the discussion of leading options in previously treated patients. I wrote that in order to answer questions like yours, Sameer, as many people are interested in this issue.

Good luck.

-Dr. West