Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Stage-4 Lung Cancer With Brain Metastasis
Question: My wife is a patient of stage-IV Lung CA with brain metastasis. She's now taking Crizotinib-500mg. However her recent MRI shows the disease is progressive. She received WBRT in 2014 and SRT in 2016. No more radiation therapy is recommended by Doctors. The treating doctors now suggesting 2nd generation ALK inhibitor - "Ceritinib". I need a second opinion on the current status and the details specified above.
Brief Answer:
Hello dear. The treatment advised is right.
Detailed Answer:
Hello dear. Welcome to HCM. I appreciate your concern. I have gone through the details. The treatment options are limited at this stage. If the metastatic lesions are symptomatic and fewer in no. and can be easily removed, then brain surgery(to remove the lesions) can also be added to the ALK inhibitor(ceritinib). Otherwise switching to another drug like ceritinib or alectinib will be adequate.
This drug can penetrate the brain and has good response rate.
Thanks and regards.
Feel free to ask further
Hello dear. The treatment advised is right.
Detailed Answer:
Hello dear. Welcome to HCM. I appreciate your concern. I have gone through the details. The treatment options are limited at this stage. If the metastatic lesions are symptomatic and fewer in no. and can be easily removed, then brain surgery(to remove the lesions) can also be added to the ALK inhibitor(ceritinib). Otherwise switching to another drug like ceritinib or alectinib will be adequate.
This drug can penetrate the brain and has good response rate.
Thanks and regards.
Feel free to ask further
Above answer was peer-reviewed by :
Dr. Sonia Raina
Hello Doctor,
Thanks for your reply. Actually I missed to mention that We did a "Gene expression profiling" recently as per the treating Dr's recommendation, by collecting sample from her right lung using CT guided biopsy. But the results are consfusing and show no active mutation to any of the FDA approved panels. Can you advice whether Gene profiling can be considered or not.
Though my wife is having multiple lesions in all parts of brain, she's stable and responsive except her vision on one eye is completely affected. She was given 8 sittings of Chemotherapy with Carboplatin and pemetrixed. Post Chemo MRI scan showed mild increase in lesions. At this stage I am quite worried about the prognosis even after Ceritinib.
Thanks for your reply. Actually I missed to mention that We did a "Gene expression profiling" recently as per the treating Dr's recommendation, by collecting sample from her right lung using CT guided biopsy. But the results are consfusing and show no active mutation to any of the FDA approved panels. Can you advice whether Gene profiling can be considered or not.
Though my wife is having multiple lesions in all parts of brain, she's stable and responsive except her vision on one eye is completely affected. She was given 8 sittings of Chemotherapy with Carboplatin and pemetrixed. Post Chemo MRI scan showed mild increase in lesions. At this stage I am quite worried about the prognosis even after Ceritinib.
Brief Answer:
Hello. Gene expression profiling is not going to help
Detailed Answer:
Hello dear. If the cancer has already been labelled as ALK rearrangement positive , there is no use of GEP.
Moreover, as your wife is asymptomatic for brain lesions, then either crizotinib can be further continued till she becomes symptomatic and then change to ceritinib or straightaway changing to ceritinib without waiting for her to get symptoms.
I am sorry to say, but the prognosis in a metastatic disease is actually not good. However she can enjoy a good quality of life with ceritinib.
Thanks and regards
Hello. Gene expression profiling is not going to help
Detailed Answer:
Hello dear. If the cancer has already been labelled as ALK rearrangement positive , there is no use of GEP.
Moreover, as your wife is asymptomatic for brain lesions, then either crizotinib can be further continued till she becomes symptomatic and then change to ceritinib or straightaway changing to ceritinib without waiting for her to get symptoms.
I am sorry to say, but the prognosis in a metastatic disease is actually not good. However she can enjoy a good quality of life with ceritinib.
Thanks and regards
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
