حول ALK+ LC

​It’s important to keep in mind that TKIs are not a cure for lung cancer, but rather a treatment that allows a tumour to be kept in check. Tumours can often be managed for years with these drugs, reducing the likelihood that the cancer cells will spread.  Hopefully, one day, lung cancer may be treated like other chronic diseases.

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TKIs can have immediate beneficial effects for some patients by significantly reducing the size and number of lesions but it is essential that patients are regularly monitored.  Leading experts recommend that CT scans should be carried out every three months.

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Lung cancer, and in particular ALK-positive lung cancer, often progresses to the brain. About 26% of patients will have brain metastases at diagnosis and about another 20% will develop brain metastases with 2 years.  We consider that it is best practice for patients to receive a brain MRI at diagnosis and, if no brain lesions are found, at six-monthly intervals thereafter.  If brain lesions are found, MRI scans should be carried out every three months.  Unfortunately, there are no national guidelines.

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ALK-positive patients have an elevated risk of developing a venous thromboembolism (blood clot) and about 18% are likely to do so within 12 months of diagnosis and about 30% within 5 years.

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Patients taking tyrosine kinase inhibitors (TKIs) should have regular electrocardiograms (ECGs) to monitor for potential cardiac side effects.1 An ECG should be taken before treatment starts to establish a base line and repeated within the next 4 weeks to detect any early changes. Thereafter, ECG may be performed at 3 – 6 month intervals, depending on the patient’s risk factors and the TKI’s cardiac risk profile. High risk patients may have monthly ECGs.

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Lung cancers may initially respond very well to targeted therapy medications. However, patients almost always become resistant to the medication over time and their cancer progresses.

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If patients develop resistance to an ALK inhibitor, their healthcare provider may try a new medication. If the progression is localised, radiotherapy may be offered.  Chemotherapy may also be offered. 

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Like other cancer medications, it can be expected that TKIs will produce side effects, although these are likely to be much less than the side effects of chemotherapy.  Each of the TKIs will produce its own side effects – some effects may be mild, others may be uncomfortable and disrupt everyday life and others may be severe.  

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​Blood tests should be taken at regular intervals to ascertain whether the treatment is affecting vital organs.  It may be necessary to reduce dosage, to pause treatment or, in severe cases, to change treatment.

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Results from a trial of the 3rd generation TKI, Lorlatinib, indicated that 6 out of 10 patients did not have any progession of their cancer after 5 years, when the drug was used as the first line of treatment. ​At present, it is not possible to predict how long individual patients will survive.

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TKIs bring the possibility of having a good quality of life and of living progression-free for many years.