ROS1 Translocation Lung Cancer: Treatment, Survival, and the Need for New Protein Inhibitors

New Study Reveals Disappointing Results in the Treatment of ROS1 Lung Cancer in the Netherlands

A recent study conducted by Deirdre Hekkelman-ten Berge, a research physician at the Erasmus Medical Center and radiologist at the Admiraal de Ruiter hospital, and her colleagues, has shed light on the occurrence and treatment outcomes of ROS1 translocation, a rare form of lung cancer, in the Netherlands. The study found that ROS1 lung cancer is sensitive to treatment with a protein inhibitor, but the results were not as promising as expected.

ROS1 translocations are genetic abnormalities that have been discovered in lung cancer patients in recent decades. These abnormalities, including EGFR, ALK, and ROS1, have led to the development of drugs that specifically target and treat these disorders. ROS1 translocations are mainly seen in non-smoking, young patients with adenocarcinoma, a non-small cell tumor commonly found in the outer parts of the lung. The protein inhibitor crizotinib was approved in 2016 for the treatment of patients with ROS1 lung cancer by the European Medicines Agency (EMA).

The study included a total of 67 patients with stage IV adenocarcinoma, representing only 0.34% of all patients with this type of lung cancer. The rarity of ROS1 translocation and the fact that not all patients are tested for genetic abnormalities contribute to the low number of cases and the limited knowledge about the disease. Three-quarters of the patients received systemic treatment, mainly with crizotinib. The two-year survival rate after crizotinib use was 53%, with a median progression-free survival of 8.6 months. While these results are disappointing compared to clinical trial outcomes, they are consistent with findings from other real-world studies. The presence or development of brain metastases was identified as a significant limiting factor for survival.

One concerning finding from the study was that only 39% of patients had a brain scan before starting treatment. To address this issue, the ESMO guideline now includes a recommendation for brain scans as standard diagnostics for ROS1 lung cancer. Given the rarity of the disease, treatment in the Netherlands is concentrated in a limited number of specialized centers. The study emphasizes the importance of international cooperation in research and the development of new medicines that are more effective in treating brain metastases.

Merel Hennink, a ROS1+ patient since 2014 and founder of the Merels World Foundation, highlights the need for collaboration and international networks to improve outcomes for patients with rare subgroups of lung cancer. Hennink suggests that researchers should share their findings, hospitals should provide study materials to each other, and patients with ROS1+ cancer should support and inform each other about new studies. Additionally, Hennink calls for realistic reimbursement of new drugs in the Netherlands to ensure that patients have access to the most effective treatments and can live longer in good health.

This study provides valuable insights into the occurrence and treatment outcomes of ROS1 lung cancer in the Netherlands. The disappointing results highlight the need for further research and the development of new protein inhibitors that are effective in treating brain metastases. International cooperation and collaboration among researchers, hospitals, and patients are crucial in improving the outcomes for patients with ROS1+ cancer.

Reference:
Real-world treatment patterns and survival of patients with ROS1 rearranged stage IV non-squamous NSCLC in the Netherlands Deirdre ten Berge, Ronald Damhuis, Joachim Aerts, Anne-Marie Dingemans Lung Cancer 2023.

What are the implications of identifying ROS1 translocations early in lung cancer patients and how can it potentially improve treatment outcomes

Entified as a significant factor affecting treatment outcomes, with patients who experienced brain metastases having significantly worse survival rates.

The study also revealed that the majority of patients experienced adverse events related to crizotinib treatment, such as gastrointestinal issues, visual disturbances, and liver enzyme abnormalities. However, these side effects were generally manageable and did not result in treatment discontinuation for most patients.

Hekkelman-ten Berge and her colleagues emphasize the importance of molecular testing in all lung cancer patients, especially those with adenocarcinoma. Identifying ROS1 translocations early on can help determine the most appropriate treatment strategy and potentially improve outcomes. They also highlight the need for further research and clinical trials to optimize treatment approaches for ROS1 lung cancer.

Overall, while the study’s results may be disappointing, they provide valuable insights into the occurrence and treatment outcomes of ROS1 translocation in the Netherlands. This study serves as a foundation for future research and the development of more effective treatment options for patients with this rare form of lung cancer.