scholarly journals Alectinib Treatment of ALK Positive Non Small Cell Lung Cancer Patients with Brain Metastases: Our Clinical Experience

PRILOZI ◽  
2020 ◽  
Vol 41 (2) ◽  
pp. 29-36
Author(s):  
Simonida Crvenkova
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Performance Status ◽  
Small Cell ◽  
Poor Performance Status ◽  
Small Cell Lung ◽  
Anaplastic Lymphoma ◽  
Nsclc Patients

AbstractSummary: Anaplastic lymphoma kinase (ALK) rearrangement is identified in approximately 3-7% of all metastatic non-small cell lung cancer (NSCLC) patients, and ALK tyrosine kinase inhibitors (TKIs) have revolutionized the management of this subset of lung cancer cases.Purpose: This study aims to show alectinib (TKI) effectiveness and safety with focus on alectinib intracranial efficacy for ALK+ NSCLC patients.Case presentation: Patient 1 was a 46-year-old woman diagnosed with non-small cell lung cancer with an echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene (ALK+). She presented with intracranial and liver metastases and poor performance status of ECOG 3. Alectinib was initiated as a second line therapy, after whole brain irradiation and discontinuation of first line chemotherapy after two cycles, due to the central nervous system progression and liver metastases. Good response was consequently achieved, characterized with improved overall performance and without significant adverse events.Patient 2 was a 53-year old man with left sided lung adenocarcinoma surgically treated in 2017. Post-operative pTNM stage was IIB with a positive resection margin- R1. He received adjuvant chemotherapy and radiotherapy. In 2019, after two and half years of being disease free, he presented with severe cerebral symptoms leading to poor performance status. CT scan of the brain showed multiple brain metastases. He was treated with first line alectinib after completion of whole brain radiotherapy. In 5 months period he got significantly better and able for work again.Conclusions: We recommend alectinib as a first and second line treatment approach for ALK+ NSCLC patients, in particular the ones with brain metastases at the time of diagnosis and poor PS.

scholarly journals CONTEMPORARY TREATMENT OF ALK POSITIVE NON SMALL CELL LUNG CANCER PATIENT WITH BRAIN METASTASES: OUR EXPERIENCE

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
S Crvenkova ◽  
Popova M
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Fusion Gene ◽  
Performance Status ◽  
Small Cell ◽  
Poor Performance Status ◽  
Small Cell Lung ◽  
Anaplastic Lymphoma ◽  
Nsclc Patients

Purpose: The aim of this study is to show alectinib efficacy and safety, with focus on alectinib intracranial efficacy. Case presentation: We report on a 46-year-old woman diagnosed as non small cell lung cancer harboring echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene. She has intracranial metastases and poor performance status of 3. We treated this patients with alectinib after whole brain irradiation and discontinuation of chemotherapy after two 2 cycles due to progressive brain and liver metastases. Good response was obtained with improving of her performance status without adverse events.   Conclusions: We recommend alectinib as a treatment approach for ALK+ NSCLC patients, especially those with CNS metastases at the time of the diagnosis and poor PS. Key words: CNS metastasis, ALK+ NSCLC patients, alectinib

scholarly journals Comparative survival in patients with brain metastases from non-small-cell lung cancer treated before and after implementation of radiosurgery

2017 ◽  
Vol 24 (2) ◽  
pp. 146 ◽  
Author(s):  
J.N. Greenspoon ◽  
P.M. Ellis ◽  
G. Pond ◽  
S. Caetano ◽  
J. Broomfield ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Performance Status ◽  
Small Cell ◽  
Small Cell Lung ◽  
Nsclc Patients

Introduction Survival after a diagnosis of brain metastasis in non-small-cell lung cancer (nsclc) is generally poor. We previously reported a median survival of approximately 4 months in a cohort of patients treated with whole-brain radiotherapy (wbrt). Since that time, we implemented a program of stereotactic radiosurgery (srs). In the present study, we examined survival and prognostic factors in a consecutive cohort of patients after the introduction of the srs program.Methods Data from a retrospective review of 167 nsclc patients with brain metastasis referred to a tertiary cancer centre during 2010–2012 were compared with data from a prior cohort of 91 patients treated during 2005–2007(“pre-srs cohort”).Results Median overall survival from the date of diagnosis of brain metastasis (4.3 months in the srs cohort vs. 3.9 months in the pre-srs cohort, p = 0.74) was not significantly different in the cohorts. The result was similar when the no-treatment group was excluded from the srs cohort. Within the srs cohort only, significant differences is overall survival were observed between treatment groups (srs, wbrt plus srs, wbrt, and no treatment), with improved survival being observed on univariate and multivariate analysis for patients receiving srs compared with patients receiving wbrt alone (p < 0.001).Conclusions No improvement in survival was observed for nsclc patients with brain metastases after the implementation of srs. Selected patients (younger age, female sex, good performance status, fewer brain metastases) treated with srs appeared to demonstrate improved survival. However, those observations might also reflect better patient selection for srs or a greater tendency to offer those patients systemic therapy in addition to srs.

scholarly journals Feasibility and effectiveness of afatinib for poor performance status patients with EGFR-mutation-positive non-small-cell lung cancer: a retrospective cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chiao-En Wu ◽  
Ching-Fu Chang ◽  
Chen-Yang Huang ◽  
Cheng-Ta Yang ◽  
Chih-Hsi Scott Kuo ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Prognostic Factors ◽  
Small Cell Lung Cancer ◽  
Disease Control ◽  
Performance Status ◽  
Poor Performance ◽  
Small Cell ◽  
Poor Performance Status ◽  
Small Cell Lung ◽  
Nsclc Patients

Abstract Background Afatinib is one of the standard treatments for patients with epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC). However, data on the use of afatinib in patients with poor performance status (PS ≥ 2) are limited. This study aimed to retrospectively review the clinical outcomes and safety of afatinib treatment in EGFR-mutation-positive (EGFRm+) NSCLC patients with PS ≥ 2. Methods The data for 62 patients who were treated at Linkou Chang Gung Memorial Hospital from January 2010 to August 2019 were retrospectively reviewed. Patients’ clinicopathological features were obtained, and univariate and multivariate analyses were performed to identify possible prognostic factors. Data on adverse events were collected to evaluate general tolerance for afatinib therapy. Results Until February 2020, the objective response rate, disease control rate, median progression-free survival (PFS), and overall survival (OS) were 58.1% (36/62), 69.4% (43/62), 8.8 months, and 12.9 months, respectively. The absence of liver metastasis (PFS: p = 0.044; OS: p = 0.061) and good disease control (p < 0.001 for PFS and OS) were independent favorable prognostic factors for PFS and OS. Bone metastasis (p = 0.036) and dose modification (reduction/interruption, p = 0.021) were predictors of disease control. Conclusion Afatinib demonstrated acceptable efficacy and safety in the current cohort. This study provided evidence to support the use of afatinib as a first-line treatment in EGFRm+ NSCLC patients with poor PS.

scholarly journals Efficacy of Alectinib in ALK-Positive Non-Small Cell Lung Cancer with Leptomeningeal Metastases Pretreated with Crizotinib

2021 ◽  
Author(s):  
zhiqin lu ◽  
Yuanyuan Liang ◽  
Xia Wang ◽  
Zhimin Zeng ◽  
Congying Zhong ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Clinical Symptoms ◽  
Performance Status ◽  
Small Cell ◽  
Poor Performance Status ◽  
Small Cell Lung ◽  
Specific Patient ◽  
Alk Positive

Abstract PurposeLeptomeningeal metastases is a fatal complication of advanced non-small cell lung cancer (NSCLC). This study aimed to assess the clinical efficacy of alectinib in ALK-positive NSCLC with LM patients previously treated with crizotinib.MethodsRetrospective study of NSCLC patients with alectinib-treated ALK- positive NSCLC and LM.ResultsFourteen patients (mean age, 55 years; 50% women) with adenocarcinoma NSCLC were included in the study. Before starting alectinib, all patients were treated with crizotinib. When LM was diagnosed, all patients had clinical symptoms. Sixteen (50%) patients had a performance status>2. Of 14 total patients, 85.7% (12/14) of the patients had a clinical and radiological responses. From the start of alectinib, median OS and PFS were 17.4 (95% CI, 8.9–25.9) and 11.6 months (95% CI: 8.4–14.8), respectively, one-year survival rate was 57.1%.ConclusionAlectinib had significant efficacy against NSCLC with LM, this efficacy was rapid in several patients, even some with poor performance status. Alectinib might be a suitable option for specific patient populations with advanced ALK-positive NSCLC with LM.

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