Our 47 year old daughter (non-smoker) was diagnosed with Stage IV NSCLC adenocarcinoma 3 months ago following 3 months of treatment for pneumonia (ie her symptoms began about 6 months ago).
Her original CT/PET scan showed a primary lung mass in the right upper lobe (10.5 x 8.5 cm) extending into the hilum and mediastinum and several hypermetabolic lymph nodes in her neck, thorax, and abdomen. Ultrasound prior to biopsy of liver metastases revealed a 2.5 x2.8 cm mass.
Genetic testing was negative for EGFR and ALK. No further testing was ordered at that time.
The oncologist ordered 5 rounds of radiation to reduce the lung mass then started 6 rounds of chemotherapy (Carboplatin, Pacitaxel and Avastin) at 3 week intervals which began the end of December.
At the end of January the doctor tested for the ROS1 mutation and it was positive.
The follow up CT scan showed a stable disease so at first the oncologist suggested after the 4th round of chemotherapy changing to maintenance with Avastin only. The oncologist is reluctant to change treatment to a targeted drug because of the chance of resistance. My daughter has remained healthy and active and has had few side effects from the chemo. The oncologist has ordered another CT scan this week to verify the tumors are stable and will decide based on those results the best course.
My questions in this forum (given the information above) is:
1) I have been reading for ALK mutations the first drug of choice is Critzotinib and not chemotherapy. ROS1 is apparently similar and also can be treated with Critzotinib. Why would an oncologist prefer the primary treatment to be chemotherapy over the targeted drug?
2) If or when resistance to Critzotinib occurs, can other target drugs be used and/or chemotherapy?
NSCLC Stage IV - 1273360
teddy
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Reply # - March 23, 2016, 12:31 PM
Hi Teddy,
Hi Teddy,
I'm so very your daughter has lung cancer. I know it is devastating to see but it's great that she is responding well and is feeling good. Dr. Weiss wrote, "Every cancer therapy has two purposes: to improve duration of life, and to improve quality of life. Every other measure of chemotherapy success, such as response rate or progression-free-survival, is a surrogate to these two true goals. I am using the broken record as my pseudo-apology for repeating this mantra repeatedly on GRACE, to my colleagues, and in my mind every time I make a treatment decision." http://cancergrace.org/lung/2010/04/16/introduction-to-first-line-thera… I imagine today he would change "Every other measure of chemotherapy" to "Every other measure of anti cancer treament" to include targeted drugs like crizotinib. So when your daughter and her care team use these goals there is certainly going to be a lot of "it depends" in the coming future.
The answer to your 2nd question is easy. Yes, people most usually use anti cancer treatments until they no longer fit their goals. They are known as "lines" of treatment. Your daughter is on 1st line treatment. Whether or not she moves right to maintenance or takes a break or moves to crizotinib is a question without an definite answer.
This is a good vb on the subject of maintenance in general. http://cancergrace.org/lung/tag/switch-maintenance/
Second opinions are never a bad idea and best taken at transition times. http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…
I think this will get you started in understanding you daughter's options. Don't hesitate to continue your questioning.
All best,
Janine