Stage 4 Squamous Lung Cancer + Alk positive - 1257307

cestlav
Posts:4

My brother-in-law (Chinese, 52 years old, has quitted smoking for 15 years) was diagnosed with stage 4 squamous lung cancer with bone mets in early April 2013. He has received both chemotherapy and radiation concurrently. He is responding well to radiation but not to chemo which has made him very weak and he has experienced some major side effects. He’s been admitted to the hospital for couple times already. He started with Cisplatin/Taxotere, then switched to Taxotere with Avastin cause he is platinum-resistant. Avastin seems to be working, finally there are some improvement. Still, we feel like we're losing him. He’ll finish all his treatment in August. Just found out that he has an Alk rearrangement, I know it is rare in squamous patients.
1. Should he start Crizotinib right after finishing his first line chemo?
2. I’ve heard Alimta works very well on patients who are Alk positive but what if they are also squamous patients?

Thank you for any advice.

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Reply # - June 15, 2013, 07:55 AM

catdander
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Avastin isn't recommended for those with squamous cell because of a possibility of dangerous bleeding problems. Here is a post on the subject, http://cancergrace.org/lung/2009/10/30/avastin-vanderbilt-phase-ii/

Crizotinib may be the best next step for him.

Let me direct you to the thread on crizotinib that is moderated by a very knowledgeable layman, I think you will find a lot of info there, http://cancergrace.org/topic/alk-or-ros1-nsclc-patient-group

Please ask followup questions after reading the avastin thread here,
Janine

Reply # - June 15, 2013, 09:59 AM

cestlav
Posts: 4

Thank you for your reply. We are totally aware of the danger of using Avastin on squamous patients. Actually, my brother-in-law is doing ok with Avastin, he doesn’t suffer from any significant side effects, not even a nose bleed. However, his chemotherapy is “killing” him. He has severe body ache and his health is deteriorating.

Reply # - June 15, 2013, 10:43 AM

catdander
Posts:

If a treatment for stage IV is too difficult for someone then you're defeating the purpose of treatment, which is to extend survival while maintaining quality of life.
It's also a mistake to be lulled into a sense of safety with avastin just because he hasn't had problems so far. It may be time to change treatments and give crizotinb a try.

I really like this post. It may not be necessary to read the whole thing but at the beginning Dr. Weiss makes a good argument for quality of life. http://cancergrace.org/lung/2010/04/16/introduction-to-first-line-thera… It begins, "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."

Janine

Reply # - June 15, 2013, 12:56 PM

Dr West
Posts: 4735

Crizotinib would certainly be a strong consideration for someone with an identified ALK rearrangement, especially if they are doing poorly on chemo. I would wonder whether the diagnosis of squamous NSCLC might be a mistake or whether the cancer is actually a mix of squamous and adenocarcinoma, as can occur about 5% of the time. It's unusual, as you know, to see an ALK rearrangement in a squamous NSCLC, though it's definitely possible. If you were to happen to determine that much or most of the cancer is actually an adenocarcinoma, then I think Alimta (pemetrexed) would be a stronger consideration than if it's squamous NSCLC. If the latter, the evidence suggests that Alimta adds no benefit vs. placebo, so all you'd get are side effects from it.

I know you understand the risks of Avastin in someone with a squamous NSCLC. Risks are also greater in patients receiving or who recently received chest radiation. It's reasonable to make individual decisions, but there's a real risk that things will be just fine right up until there's a catastrophic bleeding or wound healing complication.

Good luck.

-Dr. West

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