Lung cancer remains a significant health issue in Malaysia, particularly among seniors. For those diagnosed with ALK-positive (ALK+ve) non-small cell lung cancer (NSCLC), advancements in targeted therapies, like lorlatinib, represent a breakthrough in treatment. This article provides a comprehensive guide for newly diagnosed ALK+ve lung cancer patients and caregivers, emphasizing the role of lorlatinib (Lorviqua / Lorbrena) as an approved therapy by Pfizer for patients in Malaysia. Additionally, we explore how KALSIS – an innovative financial solution for cancer patients – supports Malaysian seniors facing high cancer treatment costs.
What is ALK-Positive Lung Cancer?
ALK-positive lung cancer is a form of disease within the NSCLC category, driven by a genetic mutation in the anaplastic lymphoma kinase (ALK) gene. This kinase mutation occurs in about 5% of NSCLC cases, most frequently affecting younger patients and non-smokers. The mutation causes the ALK protein to be overactive, leading to uncontrollable cell growth, metastasis, and tumor formation.
How is ALK-Positive Lung Cancer Diagnosed?
Early detection is key to effective treatment. Diagnostic methods include imaging tests such as low-dose CT scans and chest X-rays, along with biopsies to analyze lung tissue for cancerous cells. Additional molecular testing, including immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), helps identify specific genetic mutations, including ALK rearrangements. These advanced tests allow doctors to determine if targeted therapies like lorlatinib would be effective.
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Treatment Options for ALK-Positive Lung Cancer Patients (as of Nov 2024)
Targeted therapy for ALK+ve lung cancer primarily uses ALK inhibitors to block the cancer-driving signals from the mutated ALK kinase. Here’s an overview of commonly used ALK inhibitors:
1. Crizotinib
A first-generation ALK inhibitor that demonstrated initial efficacy in controlling the disease. However, resistance often develops and is less effective against central nervous system (CNS) metastasis.
2. Ceritinib
A second-generation ALK inhibitor designed to overcome crizotinib resistance. It’s effective in patients who have developed resistance to crizotinib, especially in cases of ALK+ve NSCLC with CNS involvement, as it has improved penetration into the CNS.
3. Alectinib
Another second-generation ALK inhibitor, alectinib, is preferred for its ability to target CNS metastases, a common challenge in advanced ALK-positive NSCLC. It has shown a higher progression-free survival (PFS) compared to crizotinib, making it a strong choice for first-line treatment.
4. Brigatinib
This second-generation ALK inhibitor is effective in patients with crizotinib-resistant ALK-positive lung cancer. Known for its activity against mutations contributing to resistance, brigatinib also shows good efficacy against CNS metastases and is considered an option for patients needing enhanced CNS protection.
5. Lorlatinib (Lorbrena / Lorviqua)
Developed by Pfizer, lorlatinib is a third-generation ALK inhibitor that has been approved for use in Malaysia to treat ALK-positive lung cancer. It is particularly effective for patients whose disease has progressed on prior ALK inhibitors like crizotinib, alectinib, or ceritinib. The U.S. Food and Drug Administration (FDA) approved lorlatinib based on clinical trials demonstrating improved progression-free survival (PFS) and CNS effects control.
Lorlatinib: A Breakthrough Drug in ALK-Positive Lung Cancer Treatment
Lorlatinib has proven highly effective for ALK+ve patients, especially those with advanced disease or brain metastasis. A pivotal study, the CROWN clinical trial, showed that lorlatinib substantially increased PFS in ALK+ve patients, with results indicating that 60% of participants treated with lorlatinib remained progression-free at the five-year mark. Notably, lorlatinib demonstrated a 94% reduction in the risk of intracranial progression, making it a crucial option for managing metastasis in the brain.
Lorlatinib also inhibits ALK phosphorylation, preventing the ALK mutation from enabling disease progression and reducing tumor growth. Its CNS effects and disease-modifying action make it an essential therapy for long-term survival in ALK-positive NSCLC patients.
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Administration and Dosage of Lorlatinib
Lorlatinib is an oral drug available in tablet form. The standard dose is 100 mg once daily. Patients with ALK-positive tumors should take lorlatinib exactly as prescribed by their physicians. Adjustments may be necessary for patients with severe hepatic or renal impairment. Monitoring plasma concentration levels is essential to managing the drug’s potential side effects.
Potential Side Effects of Lorlatinib
While lorlatinib offers substantial benefits, it can cause side effects, some of which may lead to discontinuation or dose adjustment:
• CNS Effects: Cognitive changes, mood swings, hallucinations, and speech difficulties are possible CNS-related effects.
• Cardiovascular and Metabolic Effects: PR interval prolongation, weight gain, elevated serum cholesterol, and triglyceride levels are common metabolic issues. Regular lipid panel monitoring is recommended.
• Patients may experience adverse symptoms like nausea, fatigue, and peripheral numbness. These side effects for patients with advanced disease require careful management and regular follow-ups with the oncology team.
Lorlatinib Access and Approval in Malaysia
Lorlatinib, marketed as Lorbrena / Lorviqua, is approved in Malaysia for ALK+ve NSCLC treatment. Patients should consult with their oncologists to assess eligibility for lorlatinib therapy, which may be particularly beneficial for patients with CNS involvement. The drug’s efficacy in reducing disease progression in ALK-positive lung cancer cases makes it a preferred option for eligible patients.
KALSIS: Financial Support for ALK-Positive Lung Cancer Patients in Malaysia
The cost of cancer treatment is often a significant concern, particularly for seniors on fixed incomes. KALSIS offers a solution by allowing Malaysian seniors to unlock their home equity to fund cancer treatment and manage living expenses, particularly those costs associated with medications like lorlatinib.
How KALSIS Works
KALSIS purchases homes from eligible seniors at market value, enabling them to access immediate funding. Here’s an overview of the program:
1. Year 1: Participants receive a 10% lump sum of the home’s sale price to fund initial healthcare needs.
2. Year 2 and Onwards: Participants receive annual payouts based on a percentage of the home’s value, either as a lump sum or in monthly installments, for ongoing healthcare or daily living expenses.
KALSIS operates with the principle of “age in place,” meaning seniors can continue living in their homes without the need to relocate while still receiving financial support.
Benefits for Cancer Patients With Inadequate Savings or Insurance
KALSIS allows seniors with inadequate savings or insurance to access financial support for cancer treatment, ensuring they can afford essential therapies like lorlatinib without compromising their living situation. This model enables self-reliance, empowering participants to finance their healthcare from their own wealth rather than relying on external aid, loans, or charities.
Conclusion
Lorlatinib provides hope for Malaysian seniors battling ALK-positive lung cancer. It offers extended progression-free survival and addresses the CNS effects that complicate treatment. Supported by the CROWN study, lorlatinib demonstrates efficacy in reducing disease progression, making it a vital option for patients with advanced ALK-positive NSCLC.
Coupled with the financial assistance KALSIS provides and relevant patient access programs (ALKare PLUS 2.0), seniors can access cancer treatments without the burden of financial instability, enabling them to continue living with dignity. Combining cutting-edge therapy and innovative financial support offers ALK+ve lung cancer patients and their caregivers a pathway to a higher quality of life.
To learn more about KALSIS and how it can help your family during these challenging times, visit our website or contact us via WhatsApp at +6011 5638 8580. Let us help you face the future with confidence and peace of mind.