Targeted Therapy Options for Advanced Lung Cancer with Brain Metastasis

Q: Targeted Therapy Options for Advanced Lung Cancer with Brain Metastasis

Hello： 1. <br>The effectiveness of Lurbinectedin is not very good; can I switch to Anlotinib? A： Lurbinectedin is a third-generation drug, while Anlotinib is a second-generation drug, and there are no direct comparative studies between the two. <br>If you have previously taken an

Regarding targeted therapies?

Hello, my mother was diagnosed with stage IV lung adenocarcinoma in May 2022, with ALK gene mutation detected.
Initially, she was treated with Lorbrena (lorlatinib), which controlled the disease fairly well.
However, in February 2023, she began experiencing neurological symptoms, and scans revealed metastasis to the brain.
Currently, she is undergoing whole brain radiation therapy and has been on Lorbrena for about a month, but the results seem limited.
My mother is now bedridden and unable to care for herself, with difficulties in swallowing and speech.
I have a few questions:
1.
Since Lorbrena is not very effective, can we switch to Alectinib?
2.
Is Alectinib effective for brain metastases (can it penetrate the blood-brain barrier)?
3.
If she has already taken Lorbrena and Lorbrena, will the health insurance cover Alectinib if we apply for it?
4.
If the medication is effective and the brain tumors shrink, will the neurological symptoms improve (such as paralysis in limbs, swallowing difficulties, memory decline, speech impairment, etc.)?
Thank you for your answers.

Jian'ao, 30~39 year old female. Ask Date: 2023/04/19

Dr. Jian Shuntian reply Pulmonology

Hello: 1.
The effectiveness of Lurbinectedin is not very good; can I switch to Anlotinib? A: Lurbinectedin is a third-generation drug, while Anlotinib is a second-generation drug, and there are no direct comparative studies between the two.
If you have previously taken another second-generation drug, Lenvatinib, and had a poor response, switching to Lurbinectedin may not yield better results.
If Lurbinectedin also shows poor response, switching back to the second-generation Anlotinib may not necessarily result in a response either.
2.
Is Anlotinib effective for brain metastases (can it penetrate the BBB)? A: Anlotinib has shown good efficacy for brain metastases.
3.
If I have already taken Lenvatinib and Lurbinectedin, will I be able to apply for Anlotinib with insurance coverage? A: According to insurance regulations, if a second-generation drug like Lenvatinib has been used and the response to Anlotinib is poor, you may apply for the third-generation Lurbinectedin.
Additionally, it is stipulated that switching from Lenvatinib or Anlotinib is not permitted unless there are severe adverse reactions or poor tolerance.
Whether the application will be approved depends on the reasons provided and the judgment of the reviewing physician.
4.
If the medication is effective and the brain tumors shrink, will neurological symptoms improve? (such as paralysis, swallowing function, memory decline, speech difficulties, etc.) A: Theoretically, if the tumors shrink, neurological symptoms should improve.

Reply Date: 2023/04/19

More Info

In the context of advanced lung cancer with brain metastasis, particularly in patients with ALK-positive lung adenocarcinoma, the treatment landscape can be complex and requires careful consideration of various factors, including the patient's overall health, the extent of metastasis, and previous treatment responses.

1. Switching from Lorlatinib (Lorbrena) to Alectinib (Alecensa): If your mother has not responded well to Lorlatinib, it may be reasonable to consider switching to Alectinib. Alectinib is known for its efficacy in treating ALK-positive lung cancer and has shown good results in patients with brain metastases. It is important to discuss this option with her oncologist, as they can evaluate her specific situation and determine if this switch is appropriate.

2. Effectiveness of Alectinib on Brain Metastases: Alectinib has demonstrated the ability to penetrate the blood-brain barrier (BBB), making it effective for treating brain metastases in ALK-positive lung cancer patients. Clinical studies have shown that Alectinib can lead to significant reductions in the size of brain metastases, which may help alleviate neurological symptoms.

3. Insurance Coverage for Alectinib: Regarding insurance coverage, it is essential to check with your healthcare provider or insurance company about the specifics of coverage for Alectinib after having received Lorlatinib and Lorlatinib. In many cases, if the previous treatments were ineffective, there may be a pathway for insurance approval for subsequent therapies, but this can vary based on individual insurance policies and local regulations.

4. Improvement of Neurological Symptoms: If Alectinib proves effective and leads to a reduction in the size of the brain tumors, it is possible that your mother's neurological symptoms may improve. However, the extent of improvement can vary widely among patients. Factors such as the duration of symptoms, the degree of neurological impairment, and overall health will influence recovery. Some patients may experience significant improvements in mobility, swallowing, and cognitive function, while others may see more modest changes.

In addition to these considerations, it is crucial to maintain open communication with her healthcare team. They can provide guidance on managing symptoms, potential side effects of new treatments, and supportive care options that may enhance her quality of life. Palliative care services can also be beneficial in addressing symptoms and providing support for both the patient and family members.

Lastly, regular follow-up imaging studies, such as MRI or CT scans, will be necessary to monitor the response to any new treatment and to assess the status of the brain metastases. This ongoing evaluation will help guide further treatment decisions and adjustments as needed.

In summary, switching to Alectinib could be a viable option for your mother, especially given its effectiveness against brain metastases in ALK-positive lung cancer. Discussing this with her oncologist and ensuring that all aspects of her care are coordinated will be essential in managing her condition effectively.

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