Sunday, October 31, 2010

Yet more good news.

I last wrote about ALK in June 2008. I first came upon it when sitting at the feet of Professor Dennis Wright who gave us weekly tutorials on lymphomas while I was working in Bournemouth. Anaplastic large cell lymphoma needs to be distinguished from Hodgkin's disease (both of which show CD30 positivity) and can be so distinguished because of a chromosomal translocation which produces the NPM-ALK fusion protein.

However ALK can have many other partners in lots of different cell types. The important thing about ALK is that it is a tyrosine kinase like Glivec and could be inhibited therapeutically.

In this week's New England Journal of Medicine there are a series of reports where this has happened. The new TKI (tyrosine kinase inhibitor) is called Crizotnib and the tumor it works in is non-small cell lung cancer. Like Glivec, its efficacy became apparent after a small phase I trial. This type of non-small cell lung cancer is a small subtype, comprising only 5.5%, but this might mean over 10,000 candidates a year in the USA alone. Most of this group are non-smokers with adenocarcinomas. They had mostly already had best available chemotherapy, so a 57% response rate in these patients is impressive. It is early days yet, but this represents another step along the pathway to tailored therapy for cancer.


Anonymous said...

...I have followed your recent postings and would like to inquire as to the association of CLL and carcinoids. I was diagnosed with CLL 12/07 and I also had a carcinoind removed from my lung 7/08. I am now hospitalized with difficulty breathing. Scans show a cluster of "something" in the area of the bronchiole tubes. I am scheduled for an Octreotide scan on Wednesday. Have you any experience with lung involvement with CLL OR Carcinoid? I would be interested in your thoughts. Thank you.
Karen May
New Haven, Connecticut

Terry Hamblin said...

There is no known association with CLL and carcinoid. Carcinoid syndrom only occurs if carcinoid has spread to liver or lungs. Local carcinoid shows up on an octreotide scan. I had one 2 years ago when they suspected that my lymph nodes were due to that, but I was negative. Octrotide can be used as a treatment for the syndrome.

Anonymous said...

Thank you for such a quick response. I have never experienced such debilitating respiratory distress. Am on 3L of O2, prednisone 40, and albuterol and still struggle by the time it comes for the next respiratory treatment. Will let you know how this works out. Thanks again.
Karen May