Targeting ALK-positive lung cancer: Bruce's story

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Many lung cancer patients who have never smoked and don't work around toxic chemicals or carcinogens have been found instead to have a defective gene that drives their cancer.

Now, a Food and Drug Administration-approved therapy is targeting what doctors call ALK-positive cancer, helping push patients toward remission.

Most mornings, you'll find Bruce Dunbar powering through a workout with the Westchester, New York Master's Swim Club. Bruce was a high school All-American and captain of the Princeton swim team. Now 52, swimming is good for his body and his mind.

"The truth is, it's a chance to think about what the day has in store," he said. "What life has in store."

Two years ago, Dunbar's life was flipped upside down. What doctors first thought was asthma or pneumonia was finally diagnosed as Stage 4 lung cancer. It had spread to his spine and his brain.

"As it turns out, I had 26 lesions in my brain," he recalled.

Bruce never smoked. His doctors determined he had a gene mutation driving the cancer.

"Bruce wound up having something called an ALK rearrangement, which is a mutation, different parts of the chromosome fused together, and fortunately, that has amazing drugs now," thoracic surgeon Dr. Brendon Stiles said.

In fact, just one month before Dunbar was diagnosed, the FDA approved Alecensa and his oncologist prescribed it. Four pills twice a day.

Now more than 20 months later, Dunbar has just three tumors in his brain. The tumor in his lung is only one-tenth of what it used to be.

"In November of 2017 when I was diagnosed, I wasn't sure I was going to live, let alone get back in a pool again," he said.

But with treatment, he will be swimming and competing as long as he can.

Doctors say that eventually the drug will stop working and the cancer will regrow. The hope is that the targeted therapy works long enough for researchers to refine the next generation of the drug or add another treatment like immunotherapy to keep Dunbar going.

Dunbar says he has had some minimal side effects from the drug including fatigue, weight gain and a suppressed heart rate.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY
TOPIC: TARGETING ALK POSITIVE LUNG CANCER: BRUCE'S STORY
REPORT: MB #4612

BACKGROUND: ALK positive lung cancer is a genetic alteration of a patient's lung cell DNA. It is more likely to happen in younger patients, 55 and younger, who have never smoked. The ALK mutation causes the cells to grow abnormally and behave as cancer cells. Once the cells begin to grow in the lung they can spread into other parts of the body. If the lung cancer positive for the ALK mutation is found in an earlier stage, it can be treated quickly with surgery. (Source: https://lcfamerica.org/lung-cancer-info/types-lung-cancer/alk-positive-lung-cancer/)

TREATMENT: Many patients that are diagnosed with lung cancer with ALK can be treated using targeted therapy. If the cancer is not found in an earlier stage allowing for a patient to just get surgery to remove the cancer, then they will most likely be treated with ALK inhibitors. ALK inhibitors target the ALK mutation and stop the cancer from growing and spreading. These inhibitors have been great for patients because they are effective for years. The problem with some of the older inhibitors is the cancer cells eventually develop a resistance to the drugs and can start growing again. Some newer inhibitors overcome the cancer cells resistance and re-establish the effectiveness of the drugs. Other treatments like radiation therapy, chemotherapy, and immunotherapy are also options for patients. (Source: https://lcfamerica.org/lung-cancer-info/types-lung-cancer/alk-positive-lung-cancer/)

ALECTINIB: Brendon Stiles, MD, Thoracic Surgeon, Weill Cornell Medicine & NY-Presbyterian talks about a new drug, called alectinib, to help patients with ALK positive lung cancer, and how it helped one of his patients. "Alectinib had had some studies in later stage, in the second line setting really just the month that Bruce got diagnosed, the drug got approved as first line therapy for ALK rearranged lung cancer. The important part about that was that the study had shown the drug not only worked better everywhere in the body, but it works significantly better in the brain," said Stiles. In the case of a patient like Bruce, who had stage four lung cancer, it has completely saved his life. "Almost all of his spots have almost completely shrunk. He still has some that are visible. But we don't think any are active," says Stiles. Alectinib is also much easier for patients because it is an oral therapy as compared to infusion or chemotherapy. (Source: Brendon Stiles, MD)