How do you approach acquired resistance to a targeted therapy in lung cancer? Follow the algorithm!

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The question of how best to manage "acquired resistance" to a targeted therapy like an EGFR or ALK inhibitor in someone who has had a great response for a long time can be complicated and really doesn't have a best answer.  However, other doctors and many patients here and in the brick and mortar world ask me about how I approach it, and I've got some real opinions about it.  I'll qualify my further comments by saying that my own views have evolved over the years as we've gained more information as we get more clinical data and practical experience.

Radiation to Address Cells with Resistance to Targeted Therapies

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Introduction

Thank you to member Craig for asking some excellent questions in response to my Highlights of 2011 webinar.  Thank you also to Dr. West, who emailed me to comment more on the idea of radiation for cells with acquired resistance.

We’ve spoken at length about EGFR and related mutations such as EML4/ALK and ROS1 on GRACE.  For those who are not familiar with these subjects, I will refer you to my webinar for a summary on the most recent data on EGFR, EML4/ALK and ROS1:

Q&A on ALK Inhibitor Therapy, with Drs. Ben Solomon and Ross Camidge

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Following the terrific presentations by Drs. Ben Solomon and Ross Camidge on the science and clinical experience with the novel ALK inhibitor XALKORI (crizotinib), we had a question and answer session, which is now available as a podcast. Here's the audio podcast and transcript for it (not really a video component for this one).

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drs-solomon-and-camidge-qa-on-alk-inhibition-transcript

Dr. Ross Camidge on ALK Inhibition, Molecular Screening, and Options after XALKORI

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Continuing with Dr. Ross Camidge as our focus (see yesterday's post for a brief update from him on the afatinib/cetuximab trial), today let's turn to the recent webinar program he and Dr. Ben Solomon did with us on the subject of ALK Inhibition: From Biology to FDA-Approved Therapy for Advanced NSCLC". After Dr.

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