Some patients with non-small cell lung cancer (NSCLC) have tumor mutations called “RET fusions.” RET fusions are especially common in patients who have adenocarcinoma, never smoked, and/or have no mutations in other genes commonly associated with NSCLC. In an ongoing phase II clinical trial, three patients with adenocarcinoma and RET fusions appeared to respond well to the drug cabozantinib (Cometriq). The tumors of two of the patients shrank during Cometriq treatment, while the third experienced stable disease. Further studies are needed, but these results suggest that Cometriq may be an effective treatment for NSCLC patients with RET fusions.
An ongoing phase II clinical trial of the novel cancer treatment Reolysin has shown promising results for lung cancer. Reolysin, which is produced by Oncolytics Biotech, is a form of reovirus, a virus that infects and destroys cancer cells. The clinical trial studied patients with advanced squamous cell carcinoma (SCC) of the lung, a type of non-small cell lung cancer (NSCLC), who received Reolysin in combination with chemotherapy. Nine of 21 patients showed a partial beneficial response, while another 9 patients had no disease progression; the cancer worsened in the remaining 3 patients. Similar response rates to Reolysin had been observed during the first stage of this trial last year. Oncolytics press release: http://www.oncolyticsbiotech.com/news_items/details?press_release_id=1929
The UK’s National Institute for Health and Clinical Excellence (NICE) has provisionally recommended against the use of National Health Service resources to provide crizotinib (Xalkori) to patients. NICE considers the drug to be too expensive for the expected benefit. Xalkori is used to treat patients with previously treated non-small cell lung cancer (NSCLC) who have mutations in the ALK gene. The drug has been approved in the U.S. since August, 2011, and conditionally approved in Europe since October, 2012. Patients in the UK can still get access to Xalkori, but would have to cover the cost (£4,689/$7,100 for a 30-day supply) themselves. NICE’s provisional guidance is up for comment, after which a second draft guidance will be issued. More details at: http://www.pharmatimes.com/Article/13-03-27/NICE_issues_draft_no_for_Pfizer_s_Xalkori_but_opens_consultation.aspx
“The discovery of RET fusions in lung cancers has uncovered a new therapeutic target for patients whose tumors harbor these changes. In an unselected population of non-small cell lung cancers (NSCLCs), RET fusions are present in 1-2% of cases. This incidence rises substantially, however, in never-smokers with lung adenocarcinomas that lack other known driver oncogenes. While pre-clinical data provide experimental support for the use of RET inhibitors in the treatment of RET fusion-positive tumors, clinical data on response are lacking. We report preliminary data for the first three patients treated with the RET inhibitor cabozantinib on a prospective phase 2 trial for patients with RET fusion-positive NSCLCs (NCT01639508)…”
Treatment options are limited for patients with non-small cell lung cancer (NSCLC) that has spread to the brain (brain metastases). Standard chemotherapy drugs often cannot penetrate the brain well enough to treat brain tumors, leaving radiation, surgery, or easing of symptoms as the only choices. However, drugs that target specific mutations in tumors may open up new possibilities. Some NSCLC patients who have mutations in the ALK gene are likely to benefit from treatment with ALK inhibitors like crizotinib (Xalkori). A study of NSCLC patients with ALK mutations in their lung tumors showed that ALK mutations were present in their brain tumors, too. This finding suggests that ALK inhibitors may be effective in treating brain metastases in patients with ALK-mutant NSCLC, as long as the drugs can effectively penetrate the brain.
Neutropenia (a reduction in white blood cells) is a rare, but potentially serious side effect of the cancer drug gefitinib (Iressa). Iressa is used to treat non-small cell lung cancer (NSCLC) with mutations in the EGFR gene. A patient with EGFR-mutant advanced adenocarcinoma of the lung (a type of NSCLC) was treated with Iressa. Her tumor shrank, but she experienced severe neutropenia, leaving her at risk of dangerous infections. She was switched to erlotinib (Tarceva), another EGFR inhibitor, after which her neutropenia cleared up. The patient has since continued on Tarceva without neutropenia or cancer progression for over 9 months. This case suggests that Iressa-induced neutropenia can be safely treated by switching to Tarceva, although caution should be used in drawing conclusions from a single case study.
Results from a phase II clinical trial show that Cerulean Pharma’s anticancer drug CRLX101 did not increase survival for patients with previously treated non-small cell lung cancer (NSCLC). However, CRLX101 did shrink tumor size. Cerulean took a risk by focusing on overall survival; early clinical trials often measure drug effectiveness by looking at less-challenging measures, such as treatment response rate or time to cancer worsening. Several other clinical trials of CRLX101 in different cancers, including small cell lung cancer (SCLC), are still ongoing. More details about the drug and the trial can be found at: http://www.xconomy.com/boston/2013/03/06/cerulean-pharma-arrives-at-moment-of-truth-with-cancer-drug/.