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BenjaminLevyMD
(Physician
- Oncology - Hematology/Oncology
(Verified)
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| Communities: Lung Cancer | Thank You's: 2 |
| Member Since: Jan. 2012 | Questions: 0 |
| Answers: 8 |
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Professional Statement
Dr. Levy is an Assistant Professor of Medicine at Albert Einstein College of Medicine and an attending physician at Continuum Cancer Centers of New York. He specializes in all areas of thoracic oncology, including non-small cell lung cancer, small cell lung cancer and thymic malignancies.
Dr. Levy earned his medical degree at the Medical College of Georgia in 1998. He went on to complete an internal medicine residency at Georgetown University Hospital and subsequently a hematology/oncology fellowship at New York-Presbyterian Hospital/Weill Cornell Medical Center. While at Weill Cornell, Dr. Levy received both the Department of Medicine Research Fellow of the Year Award and the 2009 American Society of Clinical Oncology Young Investigator Award for his clinical research in prostate cancer.
Dr. Levy earned his medical degree at the Medical College of Georgia in 1998. He went on to complete an internal medicine residency at Georgetown University Hospital and subsequently a hematology/oncology fellowship at New York-Presbyterian Hospital/Weill Cornell Medical Center. While at Weill Cornell, Dr. Levy received both the Department of Medicine Research Fellow of the Year Award and the 2009 American Society of Clinical Oncology Young Investigator Award for his clinical research in prostate cancer.
Professional Info
Credential:
MD
Primary specialty:
Oncology - Hematology/Oncology
Medical school:
Medical College of Georgia
Residency:
Georgetown University Hospital
Fellowship:
New York-Presbyterian Hospital-Weill Cornell
Hospital affiliation:
Continuum Health Partners of New York, Beth Israel, St. Luke's-Roosevelt
Practice address:
10 Union Square East, Suite 4C
New York, NY
10003
Practice phone number:
(212) 844-8456
Personal Bio (My story)
My current interest is the comprehensive clinical care and research development for patients with thoracic malignancies, with particular emphasis on non small cell lung cancer. Working closely with thoracic surgeons, pulmonologists, and radiation oncologists my goal is to establish clinical trials focusing on newer therapies for both locally advanced and advanced staged lung cancer. As patients are now living longer and developing lung cancer at a later age, I believe that there should be particular attention devoted to targeted, less toxic treatments in attempts to improve survival and limit side effects.
BenjaminLevyMD Activities
Medical oncologist are routinely involved in the care of patients who are diagnosed with non small cell lung cancer. No matter what stage (I-IV), our practice at Beth Israel is that a medical oncologist should be involved at least initially in all patients diagnosed with lung cancer.
Medical oncologist are routinely involved in the care of patients who are diagnosed with non small cell lung cancer. No matter what stage (I-IV), our practice at Beth Israel is that a medical oncologist should be involved at least initially in all patients diagnosed with lung cancer.
New answer by BenjaminLevyMD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Cancer Treatment Process, Oncologist, Lung Cancer, Lung Cancer Oncologist, Medical Team, Cancer
1
Answer |
3 months ago
This is a tough question for me. Taxol, to my knowledge does not commonly cause an autonomic neuropathy, rather a peripheral neuropathy. This generally presents as numbness and tingling of the hands and feet. I have never seen taxol cause an autonomic neuropahthy although this has been reported in the literature with rare case reports.
This is a tough question for me. Taxol, to my knowledge does not commonly cause an autonomic neuropathy, rather a peripheral neuropathy. This generally presents as numbness and tingling of the hands and feet. I have never seen taxol cause an autonomic neuropahthy although this has been reported in the literature with rare case reports.
New answer by BenjaminLevyMD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Chemotherapy Side Effects, Paraneoplastic Disorder, Cancer Side Effects, Side Effects, Autonomic Neuropathy, Taxol, Cancer
1
Answer |
3 months ago
Genetic mutations play a key role in NSCLC. Identifying certain, key mutations can help select targeted therapy. The two most important mutations in lung cancer right now are the EGFR and EML-4ALK mutation and are found in the subtype of lung cancer called adenocarcinoma. These mutations are more commonly found in female, asian, non-smokers. However, they are also found in smokers and males, but to a lesser degree.
Patients with the EGFR mutation are generally treated with a drug (pill) called Tarceva as first line treatment, rather than chemotherapy. Similarly, patients with the EML-4 ALK mutation are treated with a recently approved drug (pill) called Xalqori (Crizotinib). Generally patients with these mutations who are treated with the appropriate drug do very well when compared to patients who don't have the mutation and are treated with chemotherapy
Due to the dramatic responses with the use of these drugs when a mutation is identified, it is important to test for these mutation at diagnosis. Generally, when the initally biopsy is done, I make sure that there is enough material left over to send for molecular testing. It takes roughly 2 weeks to get the results back, so based on patient preference, I may start the patient on chemotherapy until the results come back.
To note, the testing of these mutations should routinely be performed in patients with stage IV NSCLC, not in patients with stage I-III (yet). Outside of a clinical trial, there is just not enough evidence yet on how to use these molecular markers in stage I to III NSCLC although this may change very soon. Genetic mutations play a key role in NSCLC. Identifying certain, key mutations can help select targeted therapy. The two most important mutations in lung cancer right now are the EGFR and EML-4ALK mutation and are found in the subtype of lung cancer called adenocarcinoma. These mutations are more commonly found in female, asian, non-smokers. However, they are also found in smokers and males, but to a lesser degree.
Patients with the EGFR mutation are generally treated with a drug (pill) called Tarceva as first line treatment, rather than chemotherapy. Similarly, patients with the EML-4 ALK mutation are treated with a recently approved drug (pill) called Xalqori (Crizotinib). Generally patients with these mutations who are treated with the appropriate drug do very well when compared to patients who don't have the mutation and are treated with chemotherapy
Due to the dramatic responses with the use of these drugs when a mutation is identified, it is important to test for these mutation at diagnosis. Generally, when the initally biopsy is done, I make sure that there is enough material left over to send for molecular testing. It takes roughly 2 weeks to get the results back, so based on patient preference, I may start the patient on chemotherapy until the results come back.
To note, the testing of these mutations should routinely be performed in patients with stage IV NSCLC, not in patients with stage I-III (yet). Outside of a clinical trial, there is just not enough evidence yet on how to use these molecular markers in stage I to III NSCLC although this may change very soon.
Patients with the EGFR mutation are generally treated with a drug (pill) called Tarceva as first line treatment, rather than chemotherapy. Similarly, patients with the EML-4 ALK mutation are treated with a recently approved drug (pill) called Xalqori (Crizotinib). Generally patients with these mutations who are treated with the appropriate drug do very well when compared to patients who don't have the mutation and are treated with chemotherapy
Due to the dramatic responses with the use of these drugs when a mutation is identified, it is important to test for these mutation at diagnosis. Generally, when the initally biopsy is done, I make sure that there is enough material left over to send for molecular testing. It takes roughly 2 weeks to get the results back, so based on patient preference, I may start the patient on chemotherapy until the results come back.
To note, the testing of these mutations should routinely be performed in patients with stage IV NSCLC, not in patients with stage I-III (yet). Outside of a clinical trial, there is just not enough evidence yet on how to use these molecular markers in stage I to III NSCLC although this may change very soon. Genetic mutations play a key role in NSCLC. Identifying certain, key mutations can help select targeted therapy. The two most important mutations in lung cancer right now are the EGFR and EML-4ALK mutation and are found in the subtype of lung cancer called adenocarcinoma. These mutations are more commonly found in female, asian, non-smokers. However, they are also found in smokers and males, but to a lesser degree.
Patients with the EGFR mutation are generally treated with a drug (pill) called Tarceva as first line treatment, rather than chemotherapy. Similarly, patients with the EML-4 ALK mutation are treated with a recently approved drug (pill) called Xalqori (Crizotinib). Generally patients with these mutations who are treated with the appropriate drug do very well when compared to patients who don't have the mutation and are treated with chemotherapy
Due to the dramatic responses with the use of these drugs when a mutation is identified, it is important to test for these mutation at diagnosis. Generally, when the initally biopsy is done, I make sure that there is enough material left over to send for molecular testing. It takes roughly 2 weeks to get the results back, so based on patient preference, I may start the patient on chemotherapy until the results come back.
To note, the testing of these mutations should routinely be performed in patients with stage IV NSCLC, not in patients with stage I-III (yet). Outside of a clinical trial, there is just not enough evidence yet on how to use these molecular markers in stage I to III NSCLC although this may change very soon.
New answer by BenjaminLevyMD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Lung Cancer Genetic Testing, Lung Cancer Tests, Genetics, Cancer Genetic Testing, Genetic Testing, Lung Cancer, Tests, Cancer, Cancer Tests
1
Answer |
3 months ago
Genetic mutations play a key role in NSCLC. Identifying certain, key mutations can help select targeted therapy. The two most important mutations in lung cancer right now are the EGFR and EML-4ALK mutation and are found in the subtype of lung cancer called adenocarcinoma. These mutations are more commonly found in female, asian, non-smokers. However, they are also found in smokers and males, but to a lesser degree.
Patients with the EGFR mutation are generally treated with a drug (pill) called Tarceva as first line treatment, rather than chemotherapy. Similarly, patients with the EML-4 ALK mutation are treated with a recently approved drug (pill) called Xalqori (Crizotinib). Generally patients with these mutations who are treated with the appropriate drug do very well when compared to patients who don't have the mutation and are treated with chemotherapy
It is important to note, that while other mutations in lung cancer do exist and can be identified (KRAS mutation, PIK-3 mutation, MET to name a few), there are no approved drugs that target these mutations like Tarceva and Xalqori do for EGFR and EML-4ALK and thus patients with these mutations are treated with standard chemotherpay. That said, there are several clinical trials open looking a new drugs that target these mutations. Genetic mutations play a key role in NSCLC. Identifying certain, key mutations can help select targeted therapy. The two most important mutations in lung cancer right now are the EGFR and EML-4ALK mutation and are found in the subtype of lung cancer called adenocarcinoma. These mutations are more commonly found in female, asian, non-smokers. However, they are also found in smokers and males, but to a lesser degree.
Patients with the EGFR mutation are generally treated with a drug (pill) called Tarceva as first line treatment, rather than chemotherapy. Similarly, patients with the EML-4 ALK mutation are treated with a recently approved drug (pill) called Xalqori (Crizotinib). Generally patients with these mutations who are treated with the appropriate drug do very well when compared to patients who don't have the mutation and are treated with chemotherapy
It is important to note, that while other mutations in lung cancer do exist and can be identified (KRAS mutation, PIK-3 mutation, MET to name a few), there are no approved drugs that target these mutations like Tarceva and Xalqori do for EGFR and EML-4ALK and thus patients with these mutations are treated with standard chemotherpay. That said, there are several clinical trials open looking a new drugs that target these mutations.
Patients with the EGFR mutation are generally treated with a drug (pill) called Tarceva as first line treatment, rather than chemotherapy. Similarly, patients with the EML-4 ALK mutation are treated with a recently approved drug (pill) called Xalqori (Crizotinib). Generally patients with these mutations who are treated with the appropriate drug do very well when compared to patients who don't have the mutation and are treated with chemotherapy
It is important to note, that while other mutations in lung cancer do exist and can be identified (KRAS mutation, PIK-3 mutation, MET to name a few), there are no approved drugs that target these mutations like Tarceva and Xalqori do for EGFR and EML-4ALK and thus patients with these mutations are treated with standard chemotherpay. That said, there are several clinical trials open looking a new drugs that target these mutations. Genetic mutations play a key role in NSCLC. Identifying certain, key mutations can help select targeted therapy. The two most important mutations in lung cancer right now are the EGFR and EML-4ALK mutation and are found in the subtype of lung cancer called adenocarcinoma. These mutations are more commonly found in female, asian, non-smokers. However, they are also found in smokers and males, but to a lesser degree.
Patients with the EGFR mutation are generally treated with a drug (pill) called Tarceva as first line treatment, rather than chemotherapy. Similarly, patients with the EML-4 ALK mutation are treated with a recently approved drug (pill) called Xalqori (Crizotinib). Generally patients with these mutations who are treated with the appropriate drug do very well when compared to patients who don't have the mutation and are treated with chemotherapy
It is important to note, that while other mutations in lung cancer do exist and can be identified (KRAS mutation, PIK-3 mutation, MET to name a few), there are no approved drugs that target these mutations like Tarceva and Xalqori do for EGFR and EML-4ALK and thus patients with these mutations are treated with standard chemotherpay. That said, there are several clinical trials open looking a new drugs that target these mutations.
New answer by BenjaminLevyMD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Lung Cancer Genetic Mutations, Cancer Genetic Mutations, Lung Cancer, Genetic Mutations, Treatment Options, Lung Cancer Treatment Options, Cancer
1
Answer |
3 months ago
Patients with stage IV NSCLC are first treated with platinum chemotherapy which is a platinum drug (either carboplatin or cisplatin) plus another drug (Gemcitabine, Paclitaxel, Docetaxel or Alimta). At some point, unfortunately, patients will progress and their tumor will grow after the first type of chemotherapy is given. Generally at that point, a second line drug is used and the platinum doublet is abandoned.
There are three approved second line drugs (Tarceva, Alimta, Docetaxel) for NSCLC but their use is dependent on what a patient got in the first line. For instance, if a patient received Carboplatin and Alimta as a first line regimen, then the second line possibilities would be Tarceva or Docetaxel. Sometimes the drug Gemcitabine is also offerred. Unlike first line therapy, second line therapy is generally just one drug, not two. Response rates (the percentage of patients whose tumors shrink) is lower in the second line (only 10 to 15% of patients' tumors will shrink) depending on the patient the drug used. While those numbers are small, there is ample data that patients who go on to receive a second line drug live longer than those that don't receive any second line drug. Patients with stage IV NSCLC are first treated with platinum chemotherapy which is a platinum drug (either carboplatin or cisplatin) plus another drug (Gemcitabine, Paclitaxel, Docetaxel or Alimta). At some point, unfortunately, patients will progress and their tumor will grow after the first type of chemotherapy is given. Generally at that point, a second line drug is used and the platinum doublet is abandoned.
There are three approved second line drugs (Tarceva, Alimta, Docetaxel) for NSCLC but their use is dependent on what a patient got in the first line. For instance, if a patient received Carboplatin and Alimta as a first line regimen, then the second line possibilities would be Tarceva or Docetaxel. Sometimes the drug Gemcitabine is also offerred. Unlike first line therapy, second line therapy is generally just one drug, not two. Response rates (the percentage of patients whose tumors shrink) is lower in the second line (only 10 to 15% of patients' tumors will shrink) depending on the patient the drug used. While those numbers are small, there is ample data that patients who go on to receive a second line drug live longer than those that don't receive any second line drug.
There are three approved second line drugs (Tarceva, Alimta, Docetaxel) for NSCLC but their use is dependent on what a patient got in the first line. For instance, if a patient received Carboplatin and Alimta as a first line regimen, then the second line possibilities would be Tarceva or Docetaxel. Sometimes the drug Gemcitabine is also offerred. Unlike first line therapy, second line therapy is generally just one drug, not two. Response rates (the percentage of patients whose tumors shrink) is lower in the second line (only 10 to 15% of patients' tumors will shrink) depending on the patient the drug used. While those numbers are small, there is ample data that patients who go on to receive a second line drug live longer than those that don't receive any second line drug. Patients with stage IV NSCLC are first treated with platinum chemotherapy which is a platinum drug (either carboplatin or cisplatin) plus another drug (Gemcitabine, Paclitaxel, Docetaxel or Alimta). At some point, unfortunately, patients will progress and their tumor will grow after the first type of chemotherapy is given. Generally at that point, a second line drug is used and the platinum doublet is abandoned.
There are three approved second line drugs (Tarceva, Alimta, Docetaxel) for NSCLC but their use is dependent on what a patient got in the first line. For instance, if a patient received Carboplatin and Alimta as a first line regimen, then the second line possibilities would be Tarceva or Docetaxel. Sometimes the drug Gemcitabine is also offerred. Unlike first line therapy, second line therapy is generally just one drug, not two. Response rates (the percentage of patients whose tumors shrink) is lower in the second line (only 10 to 15% of patients' tumors will shrink) depending on the patient the drug used. While those numbers are small, there is ample data that patients who go on to receive a second line drug live longer than those that don't receive any second line drug.
New answer by BenjaminLevyMD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Lung Cancer, Lung Cancer Treatments, Chemotherapy Treatments, Cancer Treatments, Cancer, Chemotherapy
1
Answer |
3 months ago
Chemotherapy for lung cancer has currently undergone several changes. The standard chemotherapy for patients with stage IV non-small cell lung cancer (NSCLC) is called a platinum doublet. That is either Carboplatin or Cisplatin in combination with another drug (generally the chemotherapy drugs taxol, gemcitabine, or pemetrexed).
However, recently, it appears that certain chemotherapy works better based on the subtype or histology of non small cell lung cancer that you have. This is called histology based treatment. Basically the data published suggested that if you select the chemotherpay based on histology, that patients do better. The two types of histologies of non-small cell lung cancer are adenocarcinoma and sqaumous cell. Based on recent data, it is my practice to give adenocarcinoma (the most common type) the following chemotherapy -- Cisplatin or Carboplatin in combination with a drug called Pemetrexed (Alimta). In addition, if adenocarcinoma, I generally add another drug called Avastin (for a total of three drugs). If patients have sqaumous cell, I generally offer Cisplatin or Carboplatin in combination with Gemcitabine. In summary, adenocarcinoma generally gets three drugs -- 1. Platinum (cisplatin or carboplatin), 2. Alimta and 3. Avastin (if elgible) and patients with sqaumous gets another (Cisplatin or Carboplatin) + Gemcitabine. Other acceptable standards include Platinum (Carboplatin or Cisplatin) + Taxol
Recently, there has been renewed interest to look at other markers (ERCC1, RRM, TS) in lung cancer to help select chemotherapy but thus far, this has not been proven to be better than the standard (these studies are ongoing). In mutational testing has become routine for patients who have adenocarcinoma. The two mutations that are tested for are the EGFR mutation and the ELM-4 mutation. Patient who have this mutation are generally offered oral drugs and not chemotherpay as discussed above Chemotherapy for lung cancer has currently undergone several changes. The standard chemotherapy for patients with stage IV non-small cell lung cancer (NSCLC) is called a platinum doublet. That is either Carboplatin or Cisplatin in combination with another drug (generally the chemotherapy drugs taxol, gemcitabine, or pemetrexed).
However, recently, it appears that certain chemotherapy works better based on the subtype or histology of non small cell lung cancer that you have. This is called histology based treatment. Basically the data published suggested that if you select the chemotherpay based on histology, that patients do better. The two types of histologies of non-small cell lung cancer are adenocarcinoma and sqaumous cell. Based on recent data, it is my practice to give adenocarcinoma (the most common type) the following chemotherapy -- Cisplatin or Carboplatin in combination with a drug called Pemetrexed (Alimta). In addition, if adenocarcinoma, I generally add another drug called Avastin (for a total of three drugs). If patients have sqaumous cell, I generally offer Cisplatin or Carboplatin in combination with Gemcitabine. In summary, adenocarcinoma generally gets three drugs -- 1. Platinum (cisplatin or carboplatin), 2. Alimta and 3. Avastin (if elgible) and patients with sqaumous gets another (Cisplatin or Carboplatin) + Gemcitabine. Other acceptable standards include Platinum (Carboplatin or Cisplatin) + Taxol
Recently, there has been renewed interest to look at other markers (ERCC1, RRM, TS) in lung cancer to help select chemotherapy but thus far, this has not been proven to be better than the standard (these studies are ongoing). In mutational testing has become routine for patients who have adenocarcinoma. The two mutations that are tested for are the EGFR mutation and the ELM-4 mutation. Patient who have this mutation are generally offered oral drugs and not chemotherpay as discussed above
However, recently, it appears that certain chemotherapy works better based on the subtype or histology of non small cell lung cancer that you have. This is called histology based treatment. Basically the data published suggested that if you select the chemotherpay based on histology, that patients do better. The two types of histologies of non-small cell lung cancer are adenocarcinoma and sqaumous cell. Based on recent data, it is my practice to give adenocarcinoma (the most common type) the following chemotherapy -- Cisplatin or Carboplatin in combination with a drug called Pemetrexed (Alimta). In addition, if adenocarcinoma, I generally add another drug called Avastin (for a total of three drugs). If patients have sqaumous cell, I generally offer Cisplatin or Carboplatin in combination with Gemcitabine. In summary, adenocarcinoma generally gets three drugs -- 1. Platinum (cisplatin or carboplatin), 2. Alimta and 3. Avastin (if elgible) and patients with sqaumous gets another (Cisplatin or Carboplatin) + Gemcitabine. Other acceptable standards include Platinum (Carboplatin or Cisplatin) + Taxol
Recently, there has been renewed interest to look at other markers (ERCC1, RRM, TS) in lung cancer to help select chemotherapy but thus far, this has not been proven to be better than the standard (these studies are ongoing). In mutational testing has become routine for patients who have adenocarcinoma. The two mutations that are tested for are the EGFR mutation and the ELM-4 mutation. Patient who have this mutation are generally offered oral drugs and not chemotherpay as discussed above Chemotherapy for lung cancer has currently undergone several changes. The standard chemotherapy for patients with stage IV non-small cell lung cancer (NSCLC) is called a platinum doublet. That is either Carboplatin or Cisplatin in combination with another drug (generally the chemotherapy drugs taxol, gemcitabine, or pemetrexed).
However, recently, it appears that certain chemotherapy works better based on the subtype or histology of non small cell lung cancer that you have. This is called histology based treatment. Basically the data published suggested that if you select the chemotherpay based on histology, that patients do better. The two types of histologies of non-small cell lung cancer are adenocarcinoma and sqaumous cell. Based on recent data, it is my practice to give adenocarcinoma (the most common type) the following chemotherapy -- Cisplatin or Carboplatin in combination with a drug called Pemetrexed (Alimta). In addition, if adenocarcinoma, I generally add another drug called Avastin (for a total of three drugs). If patients have sqaumous cell, I generally offer Cisplatin or Carboplatin in combination with Gemcitabine. In summary, adenocarcinoma generally gets three drugs -- 1. Platinum (cisplatin or carboplatin), 2. Alimta and 3. Avastin (if elgible) and patients with sqaumous gets another (Cisplatin or Carboplatin) + Gemcitabine. Other acceptable standards include Platinum (Carboplatin or Cisplatin) + Taxol
Recently, there has been renewed interest to look at other markers (ERCC1, RRM, TS) in lung cancer to help select chemotherapy but thus far, this has not been proven to be better than the standard (these studies are ongoing). In mutational testing has become routine for patients who have adenocarcinoma. The two mutations that are tested for are the EGFR mutation and the ELM-4 mutation. Patient who have this mutation are generally offered oral drugs and not chemotherpay as discussed above
New answer by BenjaminLevyMD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Oncology, Lung Cancer Oncology, Lung Cancer Chemotherapy, Lung Cancer, Chemotherapy Treatments, Chemotherapy
1
Answer |
3 months ago
The tests that generally used to determine is lung cancer has travelled to other parts of the body (metastasized) is either a CT scan of the chest, abdomen and pelvis or more commonly a PET scan. A PET scan in a cancer scan of the whole body that picks up tumor growth. Generally, a PET scan is considered the standard of care for patients in the initial workup of their cancer. However, if a patient has already been diagnosed and treated, either a CT scan of chest/abdomen/pelvis or a PET scan can be used. Finally, a brain MRI is generally done as well to make sure the cancer has not moved to the brain.
The tests that generally used to determine is lung cancer has travelled to other parts of the body (metastasized) is either a CT scan of the chest, abdomen and pelvis or more commonly a PET scan. A PET scan in a cancer scan of the whole body that picks up tumor growth. Generally, a PET scan is considered the standard of care for patients in the initial workup of their cancer. However, if a patient has already been diagnosed and treated, either a CT scan of chest/abdomen/pelvis or a PET scan can be used. Finally, a brain MRI is generally done as well to make sure the cancer has not moved to the brain.
New answer by BenjaminLevyMD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Lung Cancer Tests, Metastatic Cancer Tests, Metastatic Lung Cancer, Lung Cancer, Metastasis, Tests, Cancer Tests, Cancer
1
Answer |
3 months ago
All patients with stage IV NSCLC who have the most common type, called adenocarcinoma, should have their tumor tested for at least two mutations prior to treatement. These mutations are called EGFR and ELM4-ALK and mutually exclusive (they don't ever occur together). Patients who have the EGFR mutation should be treated with a drug called Tarceva, while those who have the ELM4-ALK mutation should be treated with a relatively new comer, called Crizotinib. This is a new era in lung cancer where we are able to identify a mutation and treat with a drug targeting the mutation, rather than standard chemotherapy. Keep in mind only 15% of patients with adenocarcinoma will have the EGFR mutation and even less have the ELM4-ALK mutation (3-5%), so chances are that you will not have the mutation. Once the mutation is identified and you are treated with the appropriate drug, the mutation does not need to be tested again. That said, there is a significant interest in rebiopsying patients who progress (their tumor grows) on the drugs mentioned above (Tarceva or Crizotinib) to see if the mutation in the tumor has changed to something different. This is being done in clinical trials but is not, to date, considered the standard of care. So, in short, once your tumor has been identified as having the mutation and you are started on the drug, it does not need to be tested again unless part of a clinical trial and you progress on the drug.
All patients with stage IV NSCLC who have the most common type, called adenocarcinoma, should have their tumor tested for at least two mutations prior to treatement. These mutations are called EGFR and ELM4-ALK and mutually exclusive (they don't ever occur together). Patients who have the EGFR mutation should be treated with a drug called Tarceva, while those who have the ELM4-ALK mutation should be treated with a relatively new comer, called Crizotinib. This is a new era in lung cancer where we are able to identify a mutation and treat with a drug targeting the mutation, rather than standard chemotherapy. Keep in mind only 15% of patients with adenocarcinoma will have the EGFR mutation and even less have the ELM4-ALK mutation (3-5%), so chances are that you will not have the mutation. Once the mutation is identified and you are treated with the appropriate drug, the mutation does not need to be tested again. That said, there is a significant interest in rebiopsying patients who progress (their tumor grows) on the drugs mentioned above (Tarceva or Crizotinib) to see if the mutation in the tumor has changed to something different. This is being done in clinical trials but is not, to date, considered the standard of care. So, in short, once your tumor has been identified as having the mutation and you are started on the drug, it does not need to be tested again unless part of a clinical trial and you progress on the drug.
New answer by BenjaminLevyMD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Genetics, Lung Cancer Genetic Mutations, Genetic Tests, Cancer Genetics, Lung Cancer Gene Mutations, Lung Cancer, Genetic Mutations, Gene Mutations, Lung Cancer Genetics, Non-small Cell Lung Cancer (nsclc) Genetics, Non-small Cell Lung Cancer (nsclc)
1
Answer |
3 months ago
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