NCCN Guidelines for Patients® | Lung Cancer - Non-Small Cell Lung Cancer

52 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 5 Overview of cancer treatments Targeted therapy problems. Crizotinib may harm your baby if you’re pregnant or breastfeeding. Ceritinib Ceritinib is the same type of drug as crizotinib. However, the structure of ceritinib differs from crizotinib. Thus, it is able to block phosphate when crizotinib can’t. Ceritinib is made as a pill. It should be taken on an empty stomach. However, your doctor may suggest a different dose with food. It is taken once a day. Common side effects of ceritinib are diarrhea, nausea, vomiting, abdominal pain, tiredness, not feeling hungry, and weight loss. It rarely causes severe lung, heart, and liver problems. Ceritinib may harm your baby if you’re pregnant or breastfeeding. Alectinib Alectinib is the same type of drug as crizotinib and ceritinib. However, its structure differs. Thus, it is able to block phosphate when other medicines do not. Alectinib is made as a pill. It is taken twice a day with food. Common side effects of alectinib are tiredness, constipation, swelling, and muscle pain. It rarely causes severe lung, heart, kidney, and liver problems. Alectinib may harm your baby if you’re pregnant or breastfeeding. Brigatinib Brigatinib works much like the other medicines but its structure differs. Thus, it is able to block phosphate when other medicines do not. Brigatinib is made as a pill. It can be taken with or without food. It is taken once a day. It is given at half dose for the first week of treatment. Common side effects include nausea, diarrhea, headache, cough, and tiredness. It may cause severe lung, heart, vision, and muscle problems. Brigatinib may harm your baby if you’re pregnant or breastfeeding. ROS1 rearrangement ROS1 is surface receptor that can trigger growth signals in lung cancer cells. In lung cancers with a ROS1 rearrangement, ROS1 is overactive. With overactive ROS1, new cancer cells form quickly. There are two medicines used to stop ROS1 from triggering growth signals. Ceritinib Besides ALK, ceritinib also stops growth signals from ROS1. It works by blocking the transfer of phosphate by the tyrosine kinase. Read the section, ALK rearrangement , to learn more about ceritinib. Crizotinib Besides ALK, crizotinib also stops growth signals from ROS1. It works by blocking the transfer of phosphate by the tyrosine kinase. Read the section, ALK rearrangement , to learn more about crizotinib. BRAF V600E mutation BRAF is a kinase inside of cells. It transfers phosphates from one molecule to another. The phosphate “turns on” the next growth signal in the pathway. In lung cancers with a BRAF V600E mutation, BRAF is overactive. With overactive BRAF, new cancer cells form quickly. There are three medicines to treat overactive BRAF signals. See Figure 18 . Dabrafenib + trametinib Dabrafenib and trametinib are most often used together for treatment. Dabrafenib attaches to BRAF and blocks the transfer of phosphate. Trametinib blocks the transfer of phosphate by another kinase called MEK. BRAF and MEK are within the same growth signal pathway. MEK is further down in the pathway.

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