Lung Cancer

Know your options

Everyone reacts and copes differently following a lung cancer diagnosis. Every person has to come to terms with a new reality and a large degree of uncertainty about many of the things that matter most in life.

Getting the facts about your diagnosis and available treatments will help you make the best decisions based on your situation.

Roche offers several medications for lung cancer that have shown effective results in clinical trials. One of them may be a suitable treatment option for you.

Types of lung cancer

There are several types of lung cancer and the type you have will determine which treatment is most appropriate for you. 

Lung cancer is broadly classified as either:

Non-small cell lung cancer (NSCLC), which is the most common type of lung cancer (about 85% of all cases)

Small-cell lung cancer (SCLC), which makes up around 15% of all cases.

Types of NSCLC

As researchers have learned more about NSCLC, they have discovered that in some cases, people may have an abnormality within their DNA (genes) that cause or even increase the speed at which lung cancer cells grow. These abnormalities are not hereditary – meaning that people with these types of lung cancer will not pass these on to future generations.

The main types of lung cancer where there is a ‘genomic alteration’ (ie, the cancer is caused by a problem in the DNA) are EGFRm, ALK+, and ROS1+ or NTRK+ lung cancer – there is more information on each of these below. If you are found to have one of these sub-types of lung cancer, there may be treatments available for you that are more effective than chemotherapy.

Has your cancer been tested for EGFRm, ALK+, ROS1+ and NTRK+?

To establish if you have an abnormality in your EGFR, ALK, ROS1 or NTRK genes that might be causing your lung  cancer, your doctor needs to request a special type of test for you that involves analysing a sample of your tumour tissue. This will determine whether a targeted therapy, such as Tarceva, Alecensa or Rozlytrek, is likely to be suitable for your cancer. Sometimes obtaining a sample of your tumour can be difficult. In these cases, your doctor might offer a blood-based test that looks for DNA or cells from the NSCLC in your blood sample.
If you’re not sure if you’ve had one of these tests, talk to your doctor who will be able to advise you.

EGFRm NSCLC

Epidermal Growth Factor Receptor mutation-positive (EGFRm) NSCLC

The EGFR gene is what makes a protein that helps cells control how they grow and divide. In some NSCLC cells the EGFR protein is changed and continuously turned on. This causes the cancer cells to develop in an uncontrolled way.  If you have EGFRm NSCLC, your doctor may suggest a targeted therapy (such as Tarceva) that interferes with the activity of your EGFR gene – find out about Tarceva below.

ALK+ NSCLC

Anaplastic Lymphoma Kinase fusion-positive (ALK+) NSCLC

About 5% of people with NSCLC have an abnormality in their DNA which affects a gene called Anaplastic Lymphoma Kinase (ALK). In these cases, some of the DNA in the ALK gene is ‘fused’ to some of the DNA in another gene – this is known as ALK fusion-positive (or, ALK+) NSCLC. This fusion in the ALK gene causes cells in the lung cancer to rapidly grow and spread. If you have ALK+ NSCLC, your doctor may suggest a targeted therapy known as an ‘ALK inhibitor’ (such as Alecensa), which is specifically designed to treat ALK+ NSCLC. – find out about Alecensa below.

ROS1+ NSCLC

c-ros proto-oncogene 1 fusion-positive (ROS1+) NSCLC

A small portion of people with NSCLC—about 2%—have an abnormality in their ROS1 gene. In these cases, some of the DNA in the ROS1 gene is ‘fused’ to some of the DNA in another gene – this is known as ROS1 fusion-positive (or, ROS1+) NSCLC. Under normal circumstances, the ROS1 gene makes a protein which helps the cell know how to grow and function properly – however a ROS1 gene fusion can stop the gene working correctly and cause the lung cancer in your body to grow and/or spread to other areas. If you have ROS1+ NSCLC, your doctor may suggest a targeted therapy known as a ‘ROS1 inhibitor’ (such as ROZLYTREK), which is specifically designed to treat the ROS1+ NSCLC – find out about ROZLYTREK below.

NTRK+ cancer

neurotrophic receptor tyrosine kinase fusion-positive cancer

A very small portion of people with cancer (in their lungs, or in other parts of their body) —less than 1% —have an abnormality in one of their NTRK genes (there are three of these – NTRK1, NTRK2 and NTRK3). In these cases, some of the DNA in the NTRK gene is ‘fused’ to some of the DNA in another gene – this is known as NTRK fusion-positive (or, NTRK+) NSCLC. Under normal circumstances, the NTRK genes help transmit signals that help the cell grow and survive. In a cell with a NTRK fusion, the signalling processes do not work correctly so can cause uncontrolled cell growth, and the spread of the cancer in your body. If you have NTRK+ cancer (in your lungs or in another part of your body), your doctor may suggest a targeted therapy known as a ‘NTRK inhibitor’ (such as ROZLYTREK), which is specifically designed to treat NTRK+ cancers – find out about ROZLYTREK below.

Comprehensive Genomic Profiling

You may be interested in finding out even more about your specific type of cancer. Comprehensive Genomic Profiling can search for a range of different DNA alterations that are known to drive cancer, including EGFR, ALK, ROS1 and NTRK. If there are DNA alterations that are found to be promoting your tumour’s growth, this information can help your doctor decide what might be your best treatment option.

Find out more about Comprehensive Genomic Profiling here

Has your cancer been tested for PD-L1 expression?

PD-L1 is an immune-related protein that can be found on the surface of many tissue types, including tumour cells. Tumours that are found to have high levels of PD-L1 on their cells may be more likely to respond to a type of treatment called immunotherapy. Testing for PD-L1 expression involves analysing a sample of your tumour tissue and may provide you and your doctor with information to help determine if immunotherapy may be right for you. Immunotherapy is different to a lot of other treatments. Instead of working to directly attack the cancer, immunotherapy drugs (such as Tecentriq) help boost your immune system, so that it can fight the cancer more effectively – find out about Tecentriq below.

Roche lung cancer treatments available in New Zealand

Tecentriq®
(atezolizumab)

An immunotherapy for the treatment of advanced or metastatic NSCLC and extensive-stage SCLC. Tecentriq works with your body’s own immune system to fight the cancer cells.

Alecensa®
(alectinib)

A targeted therapy for the treatment of ALK+ NSCLC which works by blocking the activity of the ALK rearranged protein.

Tarceva® (erlotinib)

A targeted therapy for the treatment of EGFRm NSCLC. which works by blocking the signal from EGFR that tells the cells to grow.

ROZLYTREK®
(entrectinib)

A targeted therapy for the treatment of ROS1+ NSCLC and NTRK+ cancer.

Avastin®
(bevacizumab)

A targeted therapy for the treatment of NSCLC that blocks vascular endothelial growth factor (VEGF).