These of us fortunate sufficient to have Dr. Camidge as a part of our care crew have been inspired to comply with these tumor markers. Colin Barton, founding father of the ALK Constructive Medical Committee, has been doing so since 2018. LabCorp presently assessments for these markers as a part of my common blood attracts, and insurance coverage pays for it. Presumably different diagnostic and insurance coverage corporations will do the identical. The 4 markers are CEA (carcinoembryonic antigen/colorectal most cancers), CA125 (ovarian), CA19.9 (pancreatic), and CA27.29 (breast). College of Colorado’s knowledge reveals that will increase in tumor markers for sufferers on oncogene-driven most cancers remedy may happen as much as 84 days prematurely of radiographic modifications of development.
My native oncologist was fairly skeptical about these assessments once I requested for them, till I gave her a duplicate of Ross’s paper. We weren’t absolutely vigilant with the assessments till March of 2023, when a small tumor confirmed up on a PET scan in my stomach. Certain sufficient, two of the markers had been barely elevated. We biopsied and located development on lorlatinib with I1171S and G1269R mutations. Particularly the tumor marker CA27.29, which is essentially the most ALK-sensitive, was out of regular vary. CA27.29 was discovered by Camidge et al to be elevated in 94% of ALK sufferers at baseline. We irradiated that belly tumor, however the markers stored going up marginally all through 2023, and in response to Dr. Camidge, “there’s one thing happening”. And proper on cue, in September a few lymph nodes in my chest began lighting up on a PET scan, whereas the tumor markers continued to inch up. Anticipating extra severe development, in November I traveled to College of Michigan for a hilar lymph node biopsy and organoid testing, which confirmed G1269A and G1202R mutations, and that NVL-655 had a great chance of success with the hilar variant. In January 2024 we irradiated two small mind lesions that confirmed up in an MRI.
Shortly thereafter, additionally in January 2024, one other pet scan confirmed peritoneal carcinomatosis; i.e. NSCLC metastasis within the belly wall, presumably ALK optimistic. On the similar time, all the 4 tumor markers had been markedly elevated past regular vary; CA27.29 spiked to 150 U/ml, and excessive regular is 38.6. I went on Brigatinib for a number of weeks to bridge to the Nuvalent Part II trial, then switched to NVL-655 on March 1 as soon as the section II trial opened. Since then, after decreasing the dose of NVL-655 twice, and holding the dosing for two-week and three-week durations for elevated liver enzymes, I’ve been on 50mg for 3 weeks straight at this writing. The symptom enchancment from February to July is critical, regardless of the lengthy dosing breaks. Tumor markers are all down considerably now; CA27.29 is at 64.2, having peaked at 150 in February.
If used correctly by your oncologist along with different testing strategies, these tumor markers can help with recurrence prediction, prognosis, and therapy monitoring. There are some limitations inside the first 4 weeks of therapy, and with central nervous system development (see the College of Colorado paper). We used the marker info by growing the frequency of scans, and by acquiring a well timed biopsy in preparation for additional anticipated metastasis. The markers are presently offering hopeful proof that NVL-655 could also be working, pending persevering with liver tolerance at 50mg, capacity to realize constant dosing, and radiographic affirmation.
Creator: Jeffrey M. Sturm BS, MA, MBA
ALK Constructive, Inc.
Member, Analysis Acceleration Committee
Member, Scientific Trials Committee
Member, Board of Administrators