Xalkori, Resistant, 2nd Generation ALK Inhibitor Chugai - Also resistant - 1250816

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shinbo
Xalkori, Resistant, 2nd Generation ALK Inhibitor Chugai - Also resistant - 1250816

Hello everyone,

Previous thread

Unfortunately I think my mother has to be one of the most easily resistant ALK+ NSCLC patient ever. After spending less than 4 months on Xalkori, she is now resistant to a 2nd generation ALK Inhibitor Chugai CH5424802 in less than two months.

It is especially disappointing considering that my mother had a 30% reduction in her first scan, the results were so good that the company actually requested a second set of CTs to confirm the shrinkage. Her adrenal met vanished and became unremarkable.

However less than a month since that first faithful scan, her cancer has progressed once again, with her liver tumor growing about a centimer, and one of her lung nodules increasing in size as well.

While her oncologist recommends moving on to another 2nd generation ALK inhibitor (LDK378) I am especially concerned with the two week washout period considering how aggressive my mother's cancer is.

As a result If anybody can provide advice in regards to treating my mother's liver met locally first would be a good idea. Either through RFA, cyberknife, Cryoablation, I just to have something done instead of waiting.

Thank you

Dr West
Reply To: Xalkori, Resistant, 2nd Generation ALK Inhibitor

I think the LDK378 approach sounds quite appealing. I just don't see any value in worrying about one metastasis when the real issue is risk of progression elsewhere, especially if you're concerned about progression in a two week period. None of the local treatments you're suggesting has any either established value or even a benefit that is easy to envision in the setting of progressing advanced NSCLC, I'm sorry to say.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

shinbo
Reply To: Xalkori, Resistant, 2nd Generation ALK Inhibitor

Dr. West,

Thank you for writing back. My family is actually considering a more aggressive stance in regards to my mother's treatment. Another option her oncologist offered was going back and retrying Xalkori with Chemotherapy instead of the LDK378. My family is considering this option since it isn't a trial and we can be more aggressive with local therapies instead of waiting for a two week washout period.

My mother's cancer in her liver grown about a centimeter from 3-4cm in just three weeks while on Chugai. I can't imagine what it would be like if she is off for two whole weeks. Would combining Crizotinib with Chemo a good option? Please advise, Thank you.

Her first chemo with Cisplatin/Carbo/Alimta didn't have a great respond either. Was wondering what would be a standard 2nd line treatment?

-Dan

catdander
Reply To: Xalkori, Resistant, 2nd Generation ALK Inhibitor

Below is a blog post written by Dr. West discussing second line options.
I hope you understand our doctors can't advise you from a forum it is illegal because they don't have all pertinent information a doctor seeing your mom has.
Another option would be to see a lung cancer expert for a second opinion.

Janine

http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-op...

http://cancergrace.org/cancer-101/2011/11/13/an-insider’s-guide-to-the-second-opinion/

Dr West
Reply To: Xalkori, Resistant, 2nd Generation ALK Inhibitor

Thank you, Janine, for that explanation. Yes, asking "please advise" as a red flag of exactly what we aren't able to do. What I can say is that I don't think it's that valuable to continue a targeted therapy if the duration of the response was relatively short (under 6 months, for instance) and/or the recent progression is fast. That suggests that the targeted therapy isn't likely to be providing much of an inhibitory effect.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

shinbo
Reply To: Xalkori, Resistant, 2nd Generation ALK Inhibitor

Dr West, one of the options my mother's oncologist proposed instead of LDK378 is retrying Xalkori in combination with a Chemo, I was wondering if my mother opt for that option, is it possible to have cyberknife or some sort of local therapy as well?

Dr West
Reply To: Xalkori, Resistant, 2nd Generation ALK Inhibitor

This is really in the range of a very personal medical recommendation, which is something we can't do. As I mentioned above, the idea of local therapy in a situation of clear progression of multifocal, metastatic disease simply doesn't make good sense. There is no anticipated benefit from it. Asking this question many times won't change that answer.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education