Patients
with ALK - positive lung tumors may be candidates for targeted therapies that can improve prognosis and decrease risk for side effects.
Pediatric patients
with ALK - positive anaplastic large cell lymphomas and inflammatory myofibroblastic tumors had strong responses to treatment with crizotinib.
Extended survival and prognostic factors for patients
with ALK - rearranged non-small-cell lung cancer and brain metastasis.
[38] A retrospective study of 90 patients
with ALK - rearranged NSCLC metastatic to the brain found that OS after the development of brain metastases was still prolonged at approximately 4 years (49.5 months), with patients frequently having multiple opportunities for salvage SRS at recurrence; 45 % of patients on follow - up had progressive brain metastases at death.
Several prospective studies show a brain metastasis prevalence of 40 % to 70 % in patients previously treated
with ALK inhibitors.
Toyokawa G, Seto T, Takenoyama M, Ichinose Y. Insights into brain metastasis in patients
with ALK + lung cancer: is the brain truly a sanctuary?
«It became clear after reading the paper that crizotinib might also work in patients
with the ALK mutation in lung cancer,» Shaw says.
Since whole - brain radiation is associated with significant cognitive effects and the use of additional radiation therapy for progression is common in this population, the Yale researchers suspect that patients
with the ALK mutation would benefit from radiation focused on individual metastases.
A drug recently developed by Pfizer, crizotinib, targets ALK and is currently given to patients
with ALK positive lung cancer when their cancer has worsened after initial chemotherapy.
Now doctors have investigated the use of crizotinib in patients
with ALK positive lung cancer who have not yet received any chemotherapy treatment.
These results are among the best in the field, offering a lot of hope to people
with ALK - positive lung cancer,» says D. Ross Camidge, MD, PhD, director of thoracic oncology at the University of Colorado Cancer Center and the trial's principal investigator.
Analysis of CTC numbers at the different time points showed that the one measurement that was statistically significantly associated with progression - free survival was a change in the number of CTCs
with ALK copy number gain over time.
How the Study Was Conducted and Results: Farace and colleagues prospectively recruited 39 patients
with ALK - rearranged NSCLC to the study.
All patients had both CTCs
with ALK rearrangements and CTCs
with ALK copy number gain before treatment and at two months.
Median progression - free survival for the 13 patients who had a decrease in the number of CTCs
with ALK copy number gain was 14.0 months, while the median progression - free survival for the 16 patients who had stable or increased numbers of CTCs
with ALK copy number gain was 6.1 months.
Patients
with ALK rearrangements do not respond to EGFR - TKIs, but are sensitive to other targeted therapies (such as ceretinib).
Not exact matches
For example, a fusion of
ALK with EML4 occurs in about 5 % of cancers and is linked to strong patient response to treatment
with crizotinib.
«Rare genetic cause of peritoneal mesothelioma points to targeted therapy: Genetic rearrangement in the
ALK gene found in young women
with mesothelioma may be targetable
with FDA - approved drugs.»
They also looked in samples collected from patients
with pleural mesothelioma — the more common form of the diseases — but none of those samples were positive for
ALK.
Three patient samples were positive for
ALK — these patients
with peritoneal mesothelioma were women
with no history of asbestos or radiation therapy exposure.
In his own practice, Chirieac is routinely examining for the presence of
ALK rearrangements for patients
with mesothelioma and educating his residents about this new finding.
They identified
ALK - positive mesotheliomas by immunohistochemistry; confirmed
with fluorescence in situ hybridization; and performed targeted next - generation sequencing of tumor DNA and RNA to get a full picture of the exact genetic rearrangement underpinning the disease.
Now, through an unexpected observation and a meticulous study of patients seen at Brigham and Women's Hospital, BWH investigators have added a fourth cause to the list: a genetic rearrangement in the
ALK gene, observed in three patients
with peritoneal mesothelioma.
Among patients
with non-small cell lung cancer (NSCLC) fueled by
ALK gene alterations who were being treated
with crizotinib (Xalkori), a decrease in the number of circulating tumor cells (CTCs) harboring increased copies of the
ALK gene over the first two months of treatment was associated
with increased progression - free survival.
Phase I / II clinical trial results reported at the American Society for Clinical Oncology (ASCO) Annual Meeting 2015 show promising results for investigational drug brigatinib against
ALK + non-small cell lung cancer (NSCLC),
with 58 of 78
ALK + patients responding to treatment, including 50 of 70 patients who had progressed after previous treatment
with crizotinib, the first licensed
ALK inhibitor.
«We look forward to conducting further research through the STARTRK - 2 phase II trial and are hopeful that treatment
with entrectinib in patients
with a range of advanced or metastatic solid tumors harboring NTRK1 / 2/3, ROS1, or
ALK gene fusions will result in very meaningful benefit.»
Multiplexed genetic screening for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (
ALK) gene rearrangements and subsequent biomarker - guided treatment is cost - effective compared
with standard chemotherapy treatment without any molecular testing in the metastatic non-small cell lung cancer (NSCLC) setting in the United States.
Some patients
with non-small cell lung cancer (NSCLC) have changes in the anaplastic lymphoma kinase (
ALK) gene, which can drive the development of their cancer.
Around 1,600 people are diagnosed
with non-small cell lung cancer in Greater Manchester every year and a proportion of these patients will have the
ALK - positive type.
«
With immunotherapies, there were better outcomes for deeper responses, but it didn't break down the same way as with targeted treatment against ALK - positive cancer,» Doebele s
With immunotherapies, there were better outcomes for deeper responses, but it didn't break down the same way as
with targeted treatment against ALK - positive cancer,» Doebele s
with targeted treatment against
ALK - positive cancer,» Doebele says.
This will establish sequential crizotinib followed by a second generation
ALK inhibitor as the standard treatment for patients
with metastatic
ALK positive lung cancer.»
In the group that received targeted treatment for
ALK - positive lung cancer, each category of tumor reduction was associated
with corresponding gains in PFS and OS.
«
ALK now becomes the second abnormal gene that we are able to successfully target in lung cancer
with drugs other than chemotherapy.»
Ceritinib provides longer progression - free survival than chemotherapy in crizotinib - pre-treated patients
with non-small-cell lung cancer harbouring an
ALK rearrangement, according to results of the phase III ASCEND - 5 study presented at the ESMO 2016 Congress in Copenhagen.
Partnering
with the U.S. Food and Drug Administration allowed Doebele and colleagues to access clinical trial data describing initial tumor response, PFS and OS for 305 patients
with stage IIIb or IV non-small cell lung cancer on trials of
ALK inhibitors and 355 similar patients on trials of immunotherapies directed at PD - 1.
«Patients
with non-small cell lung cancer (NSCLC) should receive front line therapy
with the anaplastic lymphoma kinase (
ALK) inhibitor crizotinib,» said lead author Professor Giorgio Scagliotti, head of the Department of Oncology, University of Turin, Italy.
The advent of therapies directed at tumors
with mutations in epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (
ALK), and B - Raf proto - oncogene (BRAF) genes over the past decade have dramatically changed outcomes, he says.
Testing for the EGFR mutation and
ALK rearrangements and the use of targeted therapies have given lung cancer patients the chance for survival, along
with improved quality of life and time
with loved ones.
«For about 80 percent of our patients
with lung cancer, we don't have tests like [the one for]
ALK to tell us what treatments will work best,» Shaw says.
Abbott Laboratories developed the
ALK - FISH test in partnership
with the Pfizer team developing Xalkori.
The research behind the melanoma finding and Martensen's
ALK test began in the 1970s, when a young oncologist named Dennis Slamon became obsessed
with the genetics of breast cancer.
This is good news, although research has lagged in coming up
with companion diagnostics like those for
ALK or EGFR — which means that many of the new drugs are still administered in a trial - and - error fashion to determine which will work for individual patients.
As a result, Shaw's team has begun another clinical trial
with a more potent
ALK inhibitor — LDK378, a drug made by Novartis — that might take over when Xalkori becomes less effective.
Among those
with a positive
ALK result, 9 out of 10 saw their tumors shrink or stabilize by taking Xalkori.
«Incredibly, it was positive,» Martensen says — he was among the fortunate few
with the well - defined
ALK mutation.
The super-enhancers switched on known cancer genes, including genes like
ALK, MYC, SMO and OTX2 that are associated
with medulloblastoma, researchers reported.
The immunotherapy drug pembrolizumab, when combined
with chemotherapy, doubles survival in patients
with non-squamous non-small cell lung cancer (NSNSCLC) lacking genetic changes in the EGFR or
ALK genes, when compared to...
This disorder is associated
with mutations in members of the TGF ‐ β receptor superfamily, including bone morphogenetic protein receptor ‐ 2 (BMPR ‐ 2),
Alk ‐ 1, and endoglin.
Phase 2 Trial of Brigatinib after Treatment
with Second - Generation
ALK Inhibitors in Refractory
ALK Rearranged NSCLC
Because treatment
with rapamycin also led to decreased AKT phosphorylation in
ALK + ALCL cells in our in vitro study, it is tempting to speculate that an effector protein downstream of mTOR - raptor may contribute directly or indirectly to AKT activation.