A world expert in lung cancer research answers our questions
Federico Cappuzzo is an expert in personalized treatment for lung cancer. We recently asked him to address important issues for patients’ lung cancer screening and treatment.
CareAcross: Professor Cappuzzo, as a world expert in lung cancer research, do you suggest that any patient with lung adenocarcinoma must undergo the ALK test?
Professor Cappuzzo: “ALK translocation” is an event occurring in approximately 3-5% of lung cancer patients. Drugs against such target, including crizotinib, ceritinib or alectinib, are demonstrating to change the natural history of this disease. Because of the relevance and the impact of currently available therapies on patient survival and quality of life, we need to ensure that all ALK translocated patients can receive an anti-ALK agent.
Therefore, all non-squamous lung cancer patient, as well as all never smokers (irrespective of histology) should be tested for ALK.
CareAcross: Drugs are now available which target against ALK. Do patients who receive these drugs live longer and better?
Professor Cappuzzo: Yes, available data demonstrated that anti-ALK agents are extremely effective, with a median survival exceeding 30 months, a result not conceivable few years ago for a metastatic patient.
Moreover, anti-ALK agents rapidly induce a tumor regression, with a consequent positive impact on symptoms and quality of life.
CareAcross: What do you suggest when these drugs stop working and the tumor appears active again?
Professor Cappuzzo: In presence of disease progression, it is relevant to consider different factors, including the type of progression (slow or rapid progression), patient conditions and therapeutic alternatives.
In general, in a patient with very slow progression, many oncologists prefer to continue the ALK inhibition with the same agent, eventually adding a local therapy.
In presence of rapid progression, a different therapy, mainly chemotherapy including pemetrexed is recommended. This approach could change in the future because of the evidence of efficacy of new anti-ALK compounds offering the possibility to continue with ALK inhibition by using them in sequence.
CareAcross: What is your advice for patients who have the ALK test positive and develop brain metastasis?
Professor Cappuzzo: Recent data from a phase III trial with crizotinib in front-line showed that the drug is effective even in patients with brain metastases. Other drugs, such as ceritinib or alectinib seem more effective on brain localizations. Therefore, based on current data there is no reason to preclude an anti-ALK agent to ALK+ patients with brain metastases.
About Professor Federico Cappuzzo
Professor Cappuzzo is the Director of the Department of Medical Oncology at the Ospedale Civile in Livorno, Italy.
Prior to that, he has studied in the Universities of Palermo and Milan in Italy, and has received the ESMO fellowship on Gene Therapy of Lung Cancer at the Institut Gustave Roussy, in France. He has also attended the thoracic oncology unit at Medical University of South Carolina in Charleston (USA).
Professor Cappuzzo is the author of more than 100 papers in oncology journals.