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CraiginPA

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    CraiginPA got a reaction from DrBee in ALK Positive   
    If I recall correctly, Alecensa (alectinib) was showing especially promising results as one's first ALK-targeted drug (odds of benefit & esp. longest duration), so good that it raised the question of whether it might actually be the best drug for that role although it would take a head-to-head phase 3 trial (two groups each randomly being assigned to or the other) to give a definitive answer.
    brigatinib has been considered a good 2nd line choice after crizotinib although with a risk of pneumonitis reaction.  With their phase-in approach to dosing there isn't much concern over fatal pneumonitis reaction but if pneumonitis does occur (not usual but it does occur in some patients) you could find yourself (1) excluded from certain other clinical trials of new treatments because of having had that before or (2) excluded from some future trial if they have a restriction on the number of prior ALK inhibitors tried and you've run through a couple of others by then (such trials are becoming scarcer but they had existed before).  Most people wouldn't be too concerned with these when picking their 1st ALK drug, but there are anecdotes of individuals who turned out to be unlucky with one drug or another.  I am ignorant of any data on whether or not it might have any significant advantage over crizotinib as one's first ALK drug, and I thought that as a 2nd line (after crizotinib) it was performing well, so brigatinib is certainly a respectable drug.
    Whenever the choice of treatment seems difficult, you (or your oncologist) should really consult with one of the top research oriented oncologists who have been involved with trials of these drugs from phase 1 on.  E.g., Ross Camidge at U. Colorado or Alice Shaw at MGH in Boston are tops in my book (and Camidge even offers phone consultations although insurance won't cover those).  Shaw is my oncologist (got 5 years out of crizotinib for ROS1+ due to meeting her when other docs only knew of chemo for ROS1), and I've met Camidge a few times at the big annual ASCO -- both are awesome.  Don't just assume a comment you hear on the internet reflects the latest thinking -- these doc know the latest because they are doing the work earlier and longer.
    Best hopes,
    Craig in PA
  2. Like
    CraiginPA got a reaction from Cheryncp123 in ALK Positive   
    If I recall correctly, Alecensa (alectinib) was showing especially promising results as one's first ALK-targeted drug (odds of benefit & esp. longest duration), so good that it raised the question of whether it might actually be the best drug for that role although it would take a head-to-head phase 3 trial (two groups each randomly being assigned to or the other) to give a definitive answer.
    brigatinib has been considered a good 2nd line choice after crizotinib although with a risk of pneumonitis reaction.  With their phase-in approach to dosing there isn't much concern over fatal pneumonitis reaction but if pneumonitis does occur (not usual but it does occur in some patients) you could find yourself (1) excluded from certain other clinical trials of new treatments because of having had that before or (2) excluded from some future trial if they have a restriction on the number of prior ALK inhibitors tried and you've run through a couple of others by then (such trials are becoming scarcer but they had existed before).  Most people wouldn't be too concerned with these when picking their 1st ALK drug, but there are anecdotes of individuals who turned out to be unlucky with one drug or another.  I am ignorant of any data on whether or not it might have any significant advantage over crizotinib as one's first ALK drug, and I thought that as a 2nd line (after crizotinib) it was performing well, so brigatinib is certainly a respectable drug.
    Whenever the choice of treatment seems difficult, you (or your oncologist) should really consult with one of the top research oriented oncologists who have been involved with trials of these drugs from phase 1 on.  E.g., Ross Camidge at U. Colorado or Alice Shaw at MGH in Boston are tops in my book (and Camidge even offers phone consultations although insurance won't cover those).  Shaw is my oncologist (got 5 years out of crizotinib for ROS1+ due to meeting her when other docs only knew of chemo for ROS1), and I've met Camidge a few times at the big annual ASCO -- both are awesome.  Don't just assume a comment you hear on the internet reflects the latest thinking -- these doc know the latest because they are doing the work earlier and longer.
    Best hopes,
    Craig in PA
  3. Like
    CraiginPA got a reaction from Jeff Towers in ALK Positive   
    If I recall correctly, Alecensa (alectinib) was showing especially promising results as one's first ALK-targeted drug (odds of benefit & esp. longest duration), so good that it raised the question of whether it might actually be the best drug for that role although it would take a head-to-head phase 3 trial (two groups each randomly being assigned to or the other) to give a definitive answer.
    brigatinib has been considered a good 2nd line choice after crizotinib although with a risk of pneumonitis reaction.  With their phase-in approach to dosing there isn't much concern over fatal pneumonitis reaction but if pneumonitis does occur (not usual but it does occur in some patients) you could find yourself (1) excluded from certain other clinical trials of new treatments because of having had that before or (2) excluded from some future trial if they have a restriction on the number of prior ALK inhibitors tried and you've run through a couple of others by then (such trials are becoming scarcer but they had existed before).  Most people wouldn't be too concerned with these when picking their 1st ALK drug, but there are anecdotes of individuals who turned out to be unlucky with one drug or another.  I am ignorant of any data on whether or not it might have any significant advantage over crizotinib as one's first ALK drug, and I thought that as a 2nd line (after crizotinib) it was performing well, so brigatinib is certainly a respectable drug.
    Whenever the choice of treatment seems difficult, you (or your oncologist) should really consult with one of the top research oriented oncologists who have been involved with trials of these drugs from phase 1 on.  E.g., Ross Camidge at U. Colorado or Alice Shaw at MGH in Boston are tops in my book (and Camidge even offers phone consultations although insurance won't cover those).  Shaw is my oncologist (got 5 years out of crizotinib for ROS1+ due to meeting her when other docs only knew of chemo for ROS1), and I've met Camidge a few times at the big annual ASCO -- both are awesome.  Don't just assume a comment you hear on the internet reflects the latest thinking -- these doc know the latest because they are doing the work earlier and longer.
    Best hopes,
    Craig in PA
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