New options needed, and likely, for ALK-positive lung cancer
March 30, 2014 | by Tami Dennis
People with what’s known as ALK-positive lung cancer usually develop resistance to crizotinib, the primary drug used to treat their disease. The drug’s limitations are all the more significant because its approval in 2011 was considered a crucial advance against this type of nonsmall cell lung cancer.
"This makes new therapies for ALK-positive lung cancer essential to improving and prolonging life for these patients," said Karen L. Reckamp, M.D. , M.S., co-director of City of Hope’s Lung Cancer and Thoracic Oncology Program., in an interview with MedPage Today.
Those new therapies are on the way. A new study suggests that one drug in particular shows promise in the fight against this type of cancer. The study, published online this week in the New England Journal of Medicine(NEJM), included 122 patients with nonsmall cell lung cancer linked to a genetic mutation in the ALK gene. Of those, 83 had relapsed on crizotinib (Xalkori).
In the NEJM study, the new drug ceritinib was found effective among 56 percent of patients who had relapsed on crizotinib. It was found effective among 62 percent of those who hadn’t taken crizotinib.
The findings illustrate “how genomic data is reshaping pharmaceutical development and cancer care,” the Wall Street Journal explained, adding that ceritinib is one of three so-called ALK-inhibitors jockeying for position in the marketplace.
Reckamp told Breakthroughs that the ALK inhibitors, alone and together, hold promise for people who need new options. “We need to explore the use of these new ALK inhibitors and potential combinations to improve outcomes, since resistance continues to develop in ceritinib-treated patients.”
Additional research is needed of course. “Further evaluation regarding the therapeutic dose needed and the potential toxicity should also be considered,” Reckamp said, noting the high percentage of patients who had to have their dosages reduced because of the drug’s toxicity. “It would be useful to understand whether lower doses provide similar efficacy.”
But make no mistake, the future is brightening for patients with nonsmall cell lung cancer linked to the ALK mutation, which are about 5 percent of nonsmall cell lung cancers.
“Although questions remain, ceritinib will expand our options and improve the care of patients with ALK gene rearranged NSCLC,” Reckamp said.
Learn more about City of Hope’s lung cancer program and our own research against the disease, including Reckamp's studying of the tumor microenvironment.