Support for this educational program provided by Amgen, AstraZeneca, Blueprint Medicines, Bristol Myers Squibb, Genentech, Lilly Oncology, Merck, Novartis and Pfizer.
What is an ALK-positive cancer?
Errors in the in the ALK gene are one type of lung cancer biomarker. ALK stands for anaplastic lymphoma kinase. It was originally described in lymphoma, but most ALK-positive cancers are in non-small cell lung cancer (NSCLC). The ALK gene is in your body when you are an embryo and helps in the development of the gut and nervous system. It gets turned off while you are still in the womb. For some people, it gets turned back on and fuses, or joins, with another gene. This gene change is called an ALK fusion or ALK rearrangement and can cause cancer. When this fusion happens, a patient is said to be ALK-positive.
The most common gene that ALK fuses with is called EML4. Depending on exactly where ALK is fused with the gene, there are different types of EML4-ALK fusions. At this point, the recommended course of treatment is the same for most patients who are ALK-positive, regardless of the very specific type of ALK rearrangement you may have.
How do you know if you have ALK-positive lung cancer?
To determine if your lung cancer is ALK-positive, you need to test the tumor tissue or your blood (also called a liquid biopsy). There are several different types of tests that doctors use.
- FISH analysis looks at changes in the chromosomes through tissue under a microscope.
- Immunohistochemistry (IHC) looks for proteins in the cell under a microscope.
- Next-generation sequencing/NGS (also called comprehensive biomarker testing) is when tissue from a patient’s tumor (gathered from a biopsy) is placed in a machine that looks for many possible biomarkers at one time.
- Reverse transcription polymerase chain reaction (RT-PCR) is a laboratory method used to make many copies of a specific genetic sequence for analysis.
Your doctor may perform several of these tests at the same time to help confirm results.
Learn more about the different types of biomarker tests.
Who is most likely to have ALK-positive lung cancer?
ALK-positive lung cancer represents about 4% of lung cancer diagnoses and generally appears in non-small cell lung cancer (NSCLC). Patients who are ALK-positive tend to be younger than the average lung cancer patient and do not have a smoking history. However, all patients with advanced non-squamous NSCLC should be tested for ALK rearrangements.
What are the treatment options for someone with ALK-positive cancer?
Knowing if you have ALK-positive lung cancer has the most treatment implications for advanced stage lung cancer patients. However, some patients with early-stage ALK-positive lung cancer who’ve had surgery may receive an ALK-inhibitor called Alectinib (Alecensa), with or without chemotherapy.
Patients with advanced-stage ALK-positive lung cancer will likely be prescribed an ALK-inhibitor (also called a tyrosine kinase inhibitor (TKI) at some point in their treatment. These types of drugs work to stop or inhibit cancer growth by targeting the error in the ALK gene.
Examples of ALK-Inhibitors Include:
- Alectinib (Alecensa)
- Brigatinib (Alunbrig)
- Lorlatinib (Lorbrena)
- Crizotinib (Xalkori)
- Ceritinib (Zykadia)
Eventually the cancer will likely stop responding to your current ALK-inhibitor. When this happens, your doctor will recommend one, or a combination, of the following options:
- Another ALK-inhibitor (your doctor may recommend a re-biopsy to determine if a specific ALK- resistance mutation or other changes have occurred that could guide the choice of inhibitor).
- Increasing the dose of your current ALK-inhibitor
- Traditional chemotherapy
- Immunotherapy
- Bevacizumab (Avastin), another type of targeted drug that starves the tumor
- Radiation
- A medicine that is being tested in a clinical trial
ALK-positive lung cancer may spread to a patient’s brain (called brain metastasis). In that case, your doctor will recommend one of the ALK-inhibitors that can address the cancer cells in the brain. Some patients may need surgery and/or radiation as well.
Work with your doctor to discuss your goals and options each time you have to make a treatment decision. The three big questions to ask are:
- What is the goal of this treatment?
- What are the potential side effects?
- What other options do I have?
Research is happening at a rapid pace and your doctor should be up to date on the recommendations for your specific type of lung cancer. If you don’t feel comfortable with the answers you are receiving, do not hesitate to seek out a second opinion.
Where can I get support?
- Join our free Lung Cancer Survivors online support community on Inspire where there is a large community of ALK-positive lung cancer patients
- Request an ALK-positive patient or caregiver mentor
- Call our free Lung HelpLine to talk to a healthcare professional
- Connect with the ALK Positive Group
It is important to work closely with your physicians to help monitor your medication side effects. Ask about connecting with a supportive/palliative care doctor at the beginning of your treatment to help ensure your side effects are well managed.
Lung cancer research can move at a rapid pace. Always speak with your doctor about the most up-to-date treatment guidelines.
Page last updated: October 2, 2024
