What Will Come After My First TKI?

Living with lung cancer has changed my perspective on life. I have been interested in clinical studies as well as the different lung cancer treatment options for my ALK-positive biomarker. Being an "ALKie" means I have a big chance of being treated by tyrosine kinase inhibitors (TKIs). However, these inhibitors may stop working in due time. I've heard about patients that end up progressing after months or years of undergoing TKI treatment. I am interested to know my treatment options.

How TKI treatment came into the ALK-positive picture

I had a lung biopsy and had some tests. These tests were Fluorescence In Situ Hybridization (FISH) and ImmunoHistoChemistry (IHC). The test results were posted to have a high expression of programmed death ligand (PD-L1).

The reality of high PD-L1 expression

I found out that immunotherapy, immune-based therapy, or immuno-oncology (IO) can work for patients with high values of PD-L1.

Unfortunately, most lung cancer clinical studies have shown that there is not much improvement for ALK-positive patients, even with the presence of PD-L1 when they are treated with IO. In short, IO is not for patients like me with the ALK biomarker.

Second-line TKI treatment for ALK-Positive patients

In my case, I am still on my first line of treatment. I'm taking a 2nd-generation targeted therapy drug. With this drug, I have lived longer.

I've heard of newly diagnosed patients that are using the 4th generation TKI as their first line of treatment for their lung cancer. I've also seen some lung cancer clinical studies show that TKI treatment can be used as a 2nd line treatment option. Once I become resistant to my treatment, I am confident there will be more effective TKI treatment options.

What is the role of chemotherapy for ALK-positive cancer patients?

As soon as they told me I had stage 4 lung cancer, I thought chemotherapy was my immediate treatment. At my diagnosis, I had a lung biopsy using thoracentesis.

The result was quick. They found out about my ALK-Positive fusion. Besides, I got to start my TKI right away. Since my current side effects are manageable and my body tolerates my TKI, chemotherapy has not been an option yet. Therefore, I'm going through TKI treatment first before I go into chemotherapy.

Finding a clinical trial for ALK-positive lung cancer

I've heard about current clinical trials for ALK-Positive patients whose TKIs have stopped working in our ALK-Positive groups on Facebook and Twitter. The people that participate in these studies have a wide range of different situations.

I hope that safety and tolerability can be achieved in these studies. My confidence relies on the researchers, especially the ones working with the pharmaceutical industries.

Factors I'm considering for my new treatment

Getting a second opinion is, first and foremost, the most important factor. It will be necessary so I can explore the best treatment options for my lung cancer. Secondly, my cancer care team's input is equally important. Another thing to consider is the affordability and access of the treatment. I understand that any cancer treatment is costly, and sometimes accessibility is scarce.

Living with lung cancer for years is a blessing. I am grateful there are treatment options readily available for me when I become resistant to my ALK-Positive TKI treatment. I hope to live and be treated with good quality of life.