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Crizotinib Beats Chemo in Treatment of Metastasis and Disease Control in Lung Cancer, and Potentially, Mesothelioma

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In Nov. 2013, the U.S. Food and Drug Administration granted approval to the anti-cancer drug Xalkori, known generically as crizotinib, to treat patients with late-stage, metastatic non-small cell lung cancers (NSCLC). Now, researchers believe that patients who are battling brain cancer metastasis and are treated with crizotinib may fare better than those who receive standard chemotherapy.

According to a March 28 article in Oncology Practice, crizotinib was 85% effective in controlling brain metastasis, from lung cancer, whereas chemotherapy resulted in a 45% control rate. In the phase III trial of 343 patients with NSCLC, the researchers also found that regardless of whether patients had brain metastases at baseline, the overall response rate was significantly higher with crizotinib than with the chemotherapy treatment (77% vs. 28%).

Crizotinib is prescribed for use in adults with previously treated anaplastic lymphoma kinase (ALK)-positive advanced NSCLC. Pfizer, the maker of Xalkori, reports that about 3%-5% of people with NSCLC may test positive for the ALK fusion gene. There is a potential that the marker is also present in certain pleural mesothelioma cases making it a possible treatment option for the disease.

Mesothelioma is an incurable, asbestos-caused cancer of the membranes that surround many of the body’s vital organs. The most common form, as many as eighty percent of all diagnoses, is pleural mesothelioma, where the cancer attacks the pleural tissue surrounding the lung.  Treatment for pleural mesothelioma is similar to lung cancer with chemotherapy being the primary treatment modality.

Personalized treatment has led to longer survival for lung cancer patients, according to the researchers. However, as a result, the proportion of patients who have metastases rises, with nearly 50 percent of patients with either EGFR [epidermal growth factor receptor] or ALK mutated lung cancer developing brain metastases, the researchers report. According to various studies, metastasis is the cause of nearly 90 percent of cancer deaths.

Brain metastases remain “a significant clinical problem, resulting in considerable physical and neurocognitive morbidity as well as mortality,” says Dr. Benjamin J. Solomon of the department of medical oncology, Peter MacCallum Cancer Centre, Melbourne.

Crizotinib is another step towards personalized cancer treatment that could benefit the 2,000 to 3,000 Americans diagnosed with mesothelioma each year. Personalized care targeted to a patient‘s unique characteristics and genetic makeup, such as the ALK biomarker, optimizes the potential for success of the treatment.

The researchers concluded that crizotinib should be the standard first-line therapy for patients who have advanced ALK-positive NSCLC, regardless of whether they have brain metastases.

See the March 28 issue of the Journal of Oncology for the full report.

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