One Lung Cancer Drug - Multiple Targets

Crizotinib treatment of ROS1 non small cell lung cancer

(RxWiki News) Cancer biology overlaps frequently, and some drugs designed for a specific mutation may have multiple uses, as one study shows.

A new drug developed for one subtype of non-small cell lung cancer known as anaplastic lymphoma kinase positive (ALK) may be useful for other lung cancer patients as well.

"Ask your oncologist about Xalkori."

Although it's a targeted drug, and not originally developed for this mutation, Xalkori (crizotinib) has been shown to be effective in non-small cell lung cancer patients with a genetic mutation known as ROS1.

A team from the Massachusetts General Hospital (MGH) Cancer Center elaborated on their genetic findings by describing a case where a lung cancer patient who was resistant to other forms of chemotherapy was given Xalkori.

"When he enrolled in the trial last April, this patient was extremely sick – with significant weight loss and very low oxygen levels – and was barely able to walk," says Alice Shaw, M.D., Ph.D., of the MGH Cancer Center

"Within a few days of starting crizotinib, he felt better; and by the time we scanned his chest at seven weeks, the tumors had essentially disappeared from his lungs," Dr. Shaw reported. The patient's improvement continues nine months later.

These findings help researchers understand what genes are involved in non-small cell lung cancer, and how drugs can be best used to treat patients.

dailyRx asked Fred R. Hirsch, M.D., Ph.D, professor of medicine and pathology at the University of Colorado Cancer Center, to comment on this study.

"This is a very important finding that adds to the concept of personalized medicine has come to lung cancer. It verifies that molecular testing is crucial for choice of therapy for patients with advanced lung cancer."

"Of course, the findings with ROS1 and crizotinib  are still preliminary, and need to be verified in larger studies, [but] the results are very encouraging."

Dr. Hirsch, who was not involved in this study, elaborates, "A few years ago, all patients with advanced lung cancer were treated in the same way (“one size fits all”), and now we are able to identify new subsets with promising outcome; one after the other."

In the study, 1,073 patients with non-small cell lung cancer were screened for mutations, and 18 ROS1 positive patients were identified. Samples were examined for similarities to the 31 ALK patients.

Dr. Shaw concluded that due to the similarity with ALK positive non small cell lung cancer, ROS1 positive patients should be treated with Xalkori.

Granted accelerated approval by the FDA in August of 2011 and cited as a major breakthrough for genetic-based cancer treatment, Xalkori is projected to cost in the neighborhood of $115,200 per year, or $9,600 per month.

Results were published in the Journal of Clinical Oncology.

No financial relationships were disclosed.

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Review Date: 
February 6, 2012