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About Non-Small Cell Lung Cancer

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Genetics is changing the way we look at non-small cell lung cancer (NSCLC).
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Our understanding of lung cancer is changing. What was once seen as a single illness largely linked to smoking is now recognized by doctors as a complex disease with many types and subtypes. While most people with lung cancer have the type known as NSCLC, one person’s NSCLC can be very different from another’s.

Advances in genetics are changing the way doctors treat some people with NSCLC. These discoveries are unlocking the secrets behind what makes some cancers grow and giving doctors the ability to devise treatment plans based on the genetic makeup of the person’s cancer.

Let’s explore what NSCLC is, and how it’s being treated today.

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What we know about non-small cell lung cancer (NSCLC)
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From the day you’re diagnosed with NSCLC, life changes. You begin a fight that can leave you exhausted, frustrated, and scared. But learning more about your NSCLC could give you the confidence to partner with your care team and make informed decisions. And that may help you feel more in control.

Lungs image Lungs image
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NSCLC accounts for 85% to 90% of all lung cancer cases. It can be divided into three main types:

Adenocarcinoma

Squamous cell carcinoma

Large cell carcinoma

Adenocarcinoma is the most common NSCLC, accounting for about 40% of all lung cancer cases. It primarily affects people who smoke, or used to smoke, but it is also the most common type of lung cancer seen in non-smokers. Adenocarcinoma is more common in women, and it is more likely to affect younger people than other types of lung cancer. Adenocarcinoma is usually found in the outer region of the lung. It tends to grow more slowly than other types of lung cancer.
Squamous cell carcinoma occurs in the cells that line the airways inside your lungs. Squamous cell carcinoma usually begins in the early development of these cells, and accounts for about 25% to 30% of all lung cancer cases. It is often linked to a history of smoking and tends to be found in the middle of the lungs, near a large airway.
Large cell carcinoma accounts for about 10% to 15% of lung cancers. It often grows and spreads quickly, and may appear anywhere in the lung.

Adenocarcinoma is the most common NSCLC, accounting for about 40% of all lung cancer cases. It primarily affects people who smoke, or used to smoke, but it is also the most common type of lung cancer seen in non-smokers. Adenocarcinoma is more common in women, and it is more likely to affect younger people than other types of lung cancer. Adenocarcinoma is usually found in the outer region of the lung. It tends to grow more slowly than other types of lung cancer.

Squamous cell carcinoma occurs in the cells that line the airways inside your lungs. Squamous cell carcinoma usually begins in the early development of these cells, and accounts for about 25% to 30% of all lung cancer cases. It is often linked to a history of smoking and tends to be found in the middle of the lungs, near a large airway.

Large cell carcinoma accounts for about 10% to 15% of lung cancers. It often grows and spreads quickly, and may appear anywhere in the lung.

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How NSCLC begins
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NSCLC has traditionally been associated with certain risk factors, such as smoking. But many people are surprised to learn that it can affect anyone. Men and women of different ages and races can develop NSCLC. So can people who smoke, who used to smoke, or who never smoked.

Doctors believe that long-term exposure to cancer-causing substances can damage the cells in your lungs. This damage may cause genetic changes or defects in these cells, but changes can also occur when there is no apparent cause. Some of these changes can cause the cells to grow and multiply abnormally, and this can lead to cancer.

About Non-Small Cell Lung Cancer | XALKORI® (crizotinib) | Safety Info
Find information about non-small cell lung cancer. Learn about the risks and benefits of Rx XALKORI® (crizotinib) for ALK+ or ROS1+ metastatic NSCLC.

NSCLC Treatment

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Treating NSCLC
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For NSCLC today, the general treatment options may include surgery, radiation therapy, chemotherapy, and biomarker-driven therapy. These are often used in various combinations, depending on what is best suited to the person’s cancer.

 

Biomarker-driven therapy

Chemotherapy

Radiation therapy

Surgery

Thanks to breakthroughs in genetics over the past decade, biomarker-driven therapy is giving doctors another important option for treating some people with NSCLC. For people whose tumors test positive for certain genetic factors, it may be possible to devise a course of treatment based on the particular genetic makeup of the tumor.
The aim of chemotherapy is to use anti-cancer drugs to kill cancer cells. These drugs may be injected or taken orally. They are usually given in 4 to 6 cycles, with each cycle lasting 3 to 4 weeks. Because these drugs get into the bloodstream and circulate throughout the body, this type of treatment is useful for cancers that have spread.
Radiation therapy is a treatment option that kills cancer cells with X-rays or other radioactive particles. External beam radiation is delivered from outside the body and directed at the cancer. Internal radiation therapy (Brachytherapy) uses a radioactive pellet that is placed inside the lung, directly into the cancer or next to it.
Surgery is more often an option at the early stages when the cancer is localized and has not spread outside the lung. It is often part of a plan that includes other types of treatments.

Thanks to breakthroughs in genetics over the past decade, biomarker-driven therapy is giving doctors another important option for treating some people with NSCLC. For people whose tumors test positive for certain genetic factors, it may be possible to devise a course of treatment based on the particular genetic makeup of the tumor.

The aim of chemotherapy is to use anti-cancer drugs to kill cancer cells. These drugs may be injected or taken orally. They are usually given in 4 to 6 cycles, with each cycle lasting 3 to 4 weeks. Because these drugs get into the bloodstream and circulate throughout the body, this type of treatment is useful for cancers that have spread.

Radiation therapy is a treatment option that kills cancer cells with X-rays or other radioactive particles. External beam radiation is delivered from outside the body and directed at the cancer. Internal radiation therapy (Brachytherapy) uses a radioactive pellet that is placed inside the lung, directly into the cancer or next to it.

Surgery is more often an option at the early stages when the cancer is localized and has not spread outside the lung. It is often part of a plan that includes other types of treatments.

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Biomarker testing and biomarker-driven treatments
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Magnifying glass image Magnifying glass image

As scientists study cancer cells at the molecular level, they are finding genetic changes or defects that occur in certain types of cancer. In some cases, these changes are what make the cells grow and multiply abnormally.

Biomarkers are signs of these genetic changes or defects. By testing a sample of your tumor for biomarkers, doctors can learn if your cancer has one of these defects — and then use that information to recommend specific treatment options. Biomarker-driven therapies are believed to work by blocking the activity of the defective gene that is making the cancer grow. Biomarker testing may also be referred to as molecular profiling, a tumor marker test, molecular testing, or mutation profiling.

That's why it's important for people with NSCLC that has spread to other parts of the body (also known as metastatic) to ask their doctor if biomarker testing is appropriate for them. Testing your tumor for a range of biomarkers, including ALK and ROS1, can tell your doctor which of the known genetic defects may be driving your NSCLC, and also which ones are not.

Some NSCLCs are linked to known biomarkers, including ALK or ROS1. Scientists continue to search for new genetic defects and biomarkers, hoping that these discoveries will yield more, and even better, treatment options in the future.

 

NSCLC Treatment | XALKORI® (crizotinib) | Safety Info
Learn about NSCLC treatment options. See risks & benefits of Rx XALKORI® (crizotinib) for ALK+ or ROS1+ metastatic NSCLC.

The ALK and ROS1 Genes

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Two particular genetic defects
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Advances in genetics have revealed a number of genetic changes or defects that are believed to cause some cancers to grow. Two of these defects result in genes called ALK and ROS1 fusion genes.

Everyone has the ALK and ROS1 genes in their cells. But when a part of the ALK or the ROS1 gene breaks off and reattaches the wrong way, it becomes a fusion gene. This may cause the cell to multiply out of control, resulting in cancer growth.

It’s important to know that if you test positive for ALK, you typically would not test positive for ROS1, and vice versa. Men and women of various races, ethnicities and ages have tested ALK-positive (ALK+) or ROS1-positive (ROS1+). Some have smoked, but most have never smoked.

3% to 5% of people with NSCLC test positive for the ALK fusion gene.
1% to 2% of people with NSCLC test positive for the ROS1 fusion gene.

These numbers might seem small, but not if you are one of them.

 

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Why it’s important to know about ALK and ROS1 biomarker testing
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More and more, researchers are discovering that knowing what drives the cancer helps doctors recommend the treatment of choice. XALKORI blocks the actions of the ALK and the ROS1 fusion genes. If you test positive for either the ALK or ROS1 fusion genes and your NSCLC has spread to other parts of your body, it may respond to XALKORI.

XALKORI is a prescription medicine. It treats NSCLC that has spread to other parts of the body and is caused by a defect in either one of two genes — ALK or ROS1. It is not known if XALKORI is safe and effective in children.

About ALK & ROS1 Genes | XALKORI® (crizotinib) | Safety Info
Learn about the ALK and ROS1 fusion genes in metastatic non-small cell lung cancer. See risks & benefits of Rx XALKORI® (crizotinib).

Testing for ALK and ROS1

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Testing for ALK and ROS1
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The only way to find out if your lung cancer is positive for the ALK or ROS1 fusion genes is to do a test. If testing shows that you do have ALK+ or ROS1+ NSCLC, and it has spread to other parts of your body, XALKORI may be an option for you.

Who should be tested?

As with other testing and treatment decisions, your doctor should recommend whether you should be tested for the ALK and/or the ROS1 biomarkers.

What’s involved in ALK and ROS1 testing?

Your doctor needs a sample (biopsy) of the tumor in order to have the test done. If there is enough tissue from a previous biopsy, your doctor can send this to be tested. Otherwise, another biopsy may be required. Once the tissue is sent to the lab, most results will come back within 2 weeks.

If you have any questions about testing, or about whether your tumor may be ALK+ or ROS1+, talk to your doctor.

Our Discussion Guide

If you have been diagnosed with NSCLC that has spread to other parts of the body, read through our Discussion Guide to learn more about how to talk to the members of your care team, including doctors, nurses, and loved ones.

ALK & ROS1 Testing | XALKORI® (crizotinib) | Safety Info
Find information on testing for ALK and ROS1 in metastatic non-small cell lung cancer. See risks & benefits of Rx XALKORI® (crizotinib).