My friend was diagnosed in March with NSCLC ALK positive. She started Xalkori but developed pneumonitis and almost died after 3 weeks. She was on nothing for 6 weeks and restarted Xalkori at half dose 4 weeks ago. Original MRI in April showed 2 mets that were very small. In May she had one that showed 3 small lesions and this week had MRI that showed 10 lesions with associated edema. No midline shift. She had a 7 cm liver mass that shrunk to 4 after the 3 weeks on Xalkori She had multiple bone mets that were treated with radiation. Multiple lymph node involvement that decreased with Xalkori. Her current Ct shows stable disease in this area but a new small left pulmonary effusion and bilateral bases of lungs with interstitial lung disease I am worried the Xalkori may be causing these. She does not want whole brain radiation. What is the best treatment course given these circumstances?
Stage 4 NSCLC with increasing lung mets - 1264895
stacrober2
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Reply # - July 11, 2014, 04:53 PM
Reply To: Stage 4 NSCLC with increasing lung mets
This should have said increased brain mets not lung mets. It is MRI of brain
Reply # - July 11, 2014, 11:00 PM
Reply To: Stage 4 NSCLC with increasing lung mets
The overwhelmingly leading treatment for multiple brain metastases is whole brain radiation. I understand that she doesn't want it, but that's the leading treatment.
Some of the second generation ALK inhibitors such as Zykadia (ceritinib), which was approved by the FDA in late April of this year, have activity in the brain, but most patients don't have the kind of response and good control we expect to see with whole brain radiation, and I wouldn't consider it to be a clear substitute. Zykadia certainly has much less of a track record than whole brain radiation in this setting.
And while I'm sure some radiation oncologists would do Gamma Knife radiation on the many brain metastases, it's very unlikely that Gamma Knife to many lesions will provide sustained control. Anything short of whole brain radiation is likely to still be associated with further brain metastases.
Good luck.
-Dr. West