Lung Cancer Research Round Up: July 2019

We are in a golden age of lung cancer research, but it can be hard to keep up with all the findings.  Our ALK Positive newsletter volunteers have put together this list of some of the recent research being done on lung cancer, with a focus on ALK-positive lung cancer.

Topic:  Effectiveness of Lorlatinib and ALK mutations (Dr. Shaw, Massachusetts General Hospital)

Summary:  If a patient has any measurable ALK mutations from a NGS (next-generation sequencing) tumor tissue biopsy or cfDNA (cell-free DNA) liquid biopsy (such as Guardant 360), it is more likely that. Lorlatinib will be effective than if there is no measurable ALK mutations, regardless of whether the patient had previous TKI treatments.  The authors did find that a higher number of mutations in the ALK gene correlated with a higher number of prior TKI’s.  The number of mutations did not determine whether Lorlatinib works well or not.  It was the type of mutation that determined whether Lorlatinib worked well or not.


Topic: Local Consolidative Therapy (Dr. Gomez, MD Anderson)

Summary: These papers looked at lung cancer patients with fewer than 3 metastatic lesions at initial diagnosis (sometimes known as oligometastatic cancer; oligo = few, metastatic = transference).  To enroll in the trial, patients have one prior treatment of either chemotherapy for 4 cycles or 3 months of oral TKI and were stable at the beginning of the trial.  Patients were sorted into two groups: standard of care or aggressive treatment group.  Aggressive treatment was defined by the researcher as local consolidative therapy (LCT) where patients were treated with radiation therapy or resection of all lesions, plus standard of care such as a TKI for ALK patient.  The trial was terminated early because the patients with aggressive treatment option were doing so much better than the standard of care patients. The results from Dr. Gomez’s 2016 paper were updated with a more recent 2019 publication to confirm that LCT prolonged long-term survival in oligometastatic patients. 


Topic: Crizotinib vs Alectinib (Dr. Seto, Japan)

Summary: The ASCO (American Society of Clinical Oncology) published an abstract confirming Alectinib is better than Crizotinib as a first line of treatment for patients after an average of 42 months. 


Topic:  Possible “Driver” for Lung Cancer in Chinese Patients (Dr. Peng from China and MD Anderson)

Summary: Authors looked at lung cancer patients and their germline mutations and try to answer the question why these patients have lung cancer.  Germline mutation means these changes are passed down from parents.  Authors used the patient’s samples of tumor tissue and normal tissue to compare which genes are milestones for cancer to develop.  Out of many genes screened, they pinpointed 95 genes.  The most common are: BRAC2, FANCA, MUTYH, ATM, and TP53.  Patients with germline mutation tend to have cancer 2 years earlier than comparable patients of similar age but without these mutations.  When they looked at somatic mutations (mutations other than germline mutations), KRAS and c-MET tend to be changed in the patients with pre-existing germline mutations, though TP53 was not found to be the case.  What about other common somatic mutations such as EGFR, ALK, ROS-1, RET, and BRAF?  These common somatic changes in lung cancer were not affected by having the preexisting germline mutations, the frequency between having a germline mutation vs. not having germline mutations was similar.  --That means you are “lucky” to have “hit the jackpot” by randomness! (reviewer’s comment!)


Topic: Venous Thromboembolism (VTE ) (Dr. Zer from Israel)

Summary: Clinical doctors observed that ALK patients seemed to be getting more Venous Thromboembolism (VTE) than majority of lung cancer patients.  VTE means there was blood clot started in a vein.  So, a study was done using data from patients who had been prescribed Xalkori in Israel to see if patients were diagnosed with VTE.  Out of 149 ALK patients that had Xalkori prescribed to them, 38 patients also had a diagnosis of VTE on their charts, making the frequency of VTE around 25% for this sub pool of lung cancer patients. However, non-ALK lung cancer patients rate of VTE was only around 14%.  Taking into account of age, smoking status, and other factors, this result suggests that patients with ALK lung cancer should be more aware of VTE and its increased risks. 


Disclaimer: Summaries have been written by our member, Alice Chou, and are intended for informational purposes, not as a diagnosis or medical advice. Please refer to your medical oncologist for further discussion or questions.

Cori Casebeer