Diagnosis and treatment

Treatments for advanced/metastatic ALK+ NSCLC

#

As cancer becomes advanced and spreads to different parts of your body, the way it is treated may also need to change.

These next steps in treatment vary from person to person, so it is impossible to say exactly how your treatment will change, but some potential options your healthcare team may consider, and potentially discuss with you, are briefly described below.

You may receive these treatments separately, or they may be combined in your treatment plan.

Chemotherapy
Chemotherapy works by attacking cells that are dividing and growing quickly in your body (like cancer cells) to help control the cancer. You can read more about chemotherapy here.

Targeted therapy

Targeted therapies are designed to find specific molecules on cancer cells that make them stand out from healthy cells.1 They can either be made from chemicals, or from proteins called ‘monoclonal antibodies’.

Targeted therapies include treatments known as 'ALK inhibitors', which are specifically designed to treat the mutated ALK in ALK+ NSCLC.2

You can learn more about ALK and how it is involved in NSCLC here.

How do I receive it?

Targeted therapies can be either an intravenous treatment (you can read more about IV therapies under the ‘Chemotherapy’ section, above), or pills or tablets that you can take at home. You will usually have had some tests to find out more about your cancer at a genetic, or molecular level, to determine which targeted therapies might be most effective at treating your cancer.1

Top tips

See the top tips in the ‘chemotherapy’ section here.

What side effects might I get?

Even though targeted therapies are designed to find cancer cells, they can still cause some side effects, although these can be different to those associated with chemotherapies.

The exact side effects you get will depend on what treatment you are receiving. Your healthcare team can take you through exactly what is known about your particular treatment, however as a guide, some typical side effects of targeted therapies might include:2

  • Nausea and vomiting
  • Diarrhoea
  • Fatigue (a deep and lasting tiredness)
  • Changes to your vision
  • Changes to the number of red and white blood cells in your body
  • Swelling in certain parts of the body (including the lungs)
  • Problems with your liver, nerves, and heart beat

Immunotherapy

Immunotherapy is different to a lot of other treatments. Instead of working to directly attack the cancer, immunotherapy helps boost your immune system, so that it can fight the cancer more effectively.3

How do I receive it?

Immunotherapies are usually given intravenously, through a needle in your arm or the back of your hand (you can read more about IV therapies under the ‘Chemotherapy’ section here.4

Top tips

Some people find the idea of their immune system attacking their cancer empowering,5 and there is lots of information in the news about immunotherapies being highly effective. But it’s important to be aware that not everyone who tries immunotherapy responds – in some people it just doesn’t seem to work.6 This can be disappointing, but try and focus on the fact that there are lots of other treatments available for you to try, and your healthcare team are there to support you along the way.

What side effects might I get?

Because immunotherapies work differently to other treatments, their side effects can be a little different too. Common side effects that you might experience are listed below,7 but these will vary between immunotherapies and individual people, so it’s best to ask your healthcare team for advice that’s most relevant to you:

  • Fatigue (feeling deeply tired)
  • Diarrhoea
  • Fever
  • Shortness of breath
  • Rash, and/or blisters
  • Nausea, and/or vomiting
  • Itching
  • Headache
  • Weight loss
  • Difficulty falling, or staying, asleep
  • Decreased appetite

Surgery

You may be offered surgery1 to remove certain areas of cancer from around your body. This can help manage your cancer to a certain extent, but will especially help with alleviating any areas in your body that might be struggling because of metastatic growths.8

For example, a metastasis might be blocking the stomach or bowel, making it difficult to eat or digest foods. In these instances, removing the metastasis might help alleviate some of these issues.

You can read more about surgery here.

Radiotherapy

When your cancer becomes advanced and starts growing in other areas of your body, radiotherapy might help control some of these growths.

However this will depend on where tumours are. If you have metastases that are difficult for the radiation to reach without going through healthy tissues (which could damage them), radiotherapy may not be suitable for you.8

You can read more about radiotherapy here.

Clinical trials
As mentioned previously there may be clinical trials available that would be suitable for you to join. Your healthcare team can explain more about these to you.

Palliative care

You may also be offered something called 'palliative care'.8

Many people worry that this means there's no more treatment available to help them, but this is a common misunderstanding - palliative care is there to help you live as full of a life as possible, and is different from end-of-life care. You can learn more about palliative care here.

Regardless of the other therapy options available to you, reaching the end of your treatment may be difficult to process or reconcile. If this is the case for you, read on to learn more about where you can find support during times like this.

ALKAnaplastic lymphoma kinase
NSCLCNon-small cell lung cancer

  1. Cancer Research UK. What are targeted cancer drugs? 2017. Available from: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/targeted-cancer-drugs/what-are-targeted-cancer-drugs. Last accessed August 2019.
  2. American Cancer Society. Targeted Therapy drugs for Non-Small Cell Lung Cancer. 2018. Available from: https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/targeted-therapies.html. Last accessed August 2019.
  3. Cancer.net. Understanding immunotherapy. 2019. Available from: https://www.cancer.net/navigating-cancer-care/how-cancer-treated/immunotherapy-and-vaccines/understanding-immunotherapy. Last accessed August 2019.
  4. American Cancer Society. Immune checkpoint inhibitors. 2019. Available from: https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/immunotherapy.html. Last accessed August 2019.
  5. Cancer.net. What it’s like taking immunotherapy to treat cancer. 2017. Available from: https://www.cancer.net/blog/2017-08/what-its-taking-immunotherapy-treat-cancer. Last accessed August 2019.
  6. Darvin P et al. Exp Mol Med 2018; 50(12): 165.
  7. Cancer.net. What you need to know about immunotherapy side effects. 2018. Available from: https://www.cancer.net/blog/2018-02/what-you-need-know-about-immunotherapy-side-effects. Last accessed August 2019.
  8. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guideline in Oncology: Non-Small Cell Lung Cancer, Version 2.2019. 2018.