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Living with cancer· Appointment prep

Appointment sheet: ALK-positive non-small-cell lung cancer

One page to bring and write on: your details, the questions for ALK-positive non-small-cell lung cancer plus your own, the words you may hear, what to bring, the treatments the standard of care names, and room for the answers and agreed next steps. What you type stays in this browser. Print it or save it as a PDF. New to all this? Start with the first 60 days. Orientation, not medical advice.

Tick the questions to print

All of this cancer's questions start ticked. Untick what does not apply; ticks are kept in this browser. .

Your own questions

Shared with the prep pack, so questions you add there appear here too.

Print or save as PDF

Use (or Ctrl+P, Cmd+P on a Mac). To keep a copy, choose Save as PDF as the destination in the print dialog. Only the sheet prints; the controls stay on screen. Your typed notes print where you typed them; empty fields print as ruled lines to write on.

Appointment sheet

ALK-positive non-small-cell lung cancer

Prepared with OnCo (onco.cc/prep/alk-positive-nsclc/). Orientation, not medical advice; your team knows your case.

My details

Name
Date of appointment
Hospital and clinician
Who is coming with me

What I know, what is unclear, changes to discuss

Saved in this browser
What I know so far
What is unclear to me
Changes since last time

My questions

22 on the sheet
Newly diagnosed
  1. 1.What is my exact diagnosis, stage, and grade, and which tests established them?
  2. 2.Which biomarkers have been tested on my tumour (for example ALK fusion by immunohistochemistry, fluorescence in situ hybridisation or RNA sequencing, ALK resistance mutations at progressionby tissue or plasma sequencing, EML4-ALK variant, TP53 co-mutation, Brain MRI at diagnosis and during follow-up), and what were the results?
  3. 3.Which subtype is my cancer, and does that change the recommended treatment?
  4. 4.Is germline (inherited) genetic testing recommended for me or my family?
Advanced, first line
  1. 5.For my situation (advanced, first line), which of the standard options do you recommend and why?
  2. 6.Am I a candidate for Alectinib, Brigatinib, Lorlatinib, and what side effects should I expect?
  3. 7.How do the results of ALEX and ALTA-1L apply to someone like me?
Advanced, after a second-generation inhibitor
  1. 8.For my situation (advanced, after a second-generation inhibitor), which of the standard options do you recommend and why?
  2. 9.Am I a candidate for Lorlatinib, Pemetrexed, Carboplatin, and what side effects should I expect?
Advanced, after lorlatinib
  1. 10.For my situation (advanced, after lorlatinib), which of the standard options do you recommend and why?
  2. 11.Am I a candidate for Neladalkib, Pemetrexed, and what side effects should I expect?
  3. 12.How do the results of ALKOVE-1 apply to someone like me?
Resected stage IB to IIIA
  1. 13.For my situation (resected stage ib to iiia), which of the standard options do you recommend and why?
  2. 14.Am I a candidate for Alectinib, and what side effects should I expect?
  3. 15.How do the results of ALINA apply to someone like me?
Brain metastases
  1. 16.For my situation (brain metastases), which of the standard options do you recommend and why?
  2. 17.Am I a candidate for Lorlatinib, Alectinib, and what side effects should I expect?
Any stage
  1. 18.Are there clinical trials I could join, for example of Neladalkib, ALKOVE-1, Iruplinalkib, Ensartinib?
  2. 19.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
  3. 20.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
  4. 21.I read that “Whether any sequence of inhibitors cures metastatic ALK-positive disease or only holds it is unknown”. How does that affect my plan?
  5. 22.I read that “Lorlatinib's cognitive, mood and metabolic effects are managed by dose reduction without trials of the optimal dose”. How does that affect my plan?

The words I may hear

  • Whole-brain radiotherapy (WBRT): Irradiating the entire brain, typically 30 Gy in 10 sessions, when metastases are too numerous or too widespread (leptomeningeal) for focused radiosurgery.
  • Oligoprogression: When only one or two spots grow on an otherwise working targeted therapy; treat the spots and keep the pill.
  • On-target resistance mutations (gatekeeper, solvent-front, compound): When a cancer becomes resistant to a targeted pill, it often does so by changing the exact spot where the drug binds: a 'gatekeeper' or 'solvent-front' mutation.
  • Oncogene addiction: When a cancer depends so completely on one mutated gene that blocking it collapses the tumour.
  • Tyrosine kinase inhibitor (TKI): Pills that block the on-switch enzyme (a kinase) that a particular cancer depends on: imatinib for CML, osimertinib for EGFR lung cancer, ibrutinib for CLL.
  • Drug resistance (primary and acquired): Why cancer drugs stop working: the tumour either never depended on the target or evolves around the block.
  • Gene fusion: A gene fusion is two genes broken and joined together, creating a hybrid protein that can drive cancer.
  • Neoadjuvant / adjuvant / perioperative: Neoadjuvant therapy is treatment given before surgery, adjuvant therapy is treatment given after it, and perioperative therapy is both.
  • Brain metastases (intracranial disease): Tumour deposits that have travelled to the brain from a cancer elsewhere, ten times more common than cancers that start in the brain, mostly from lung, breast, melanoma and kidney cancer.

Tests and results to bring

Biomarker results to ask for: ALK fusion by immunohistochemistry, fluorescence in situ hybridisation or RNA sequencing, ALK resistance mutations at progression (G1202R, compound mutations) by tissue or plasma sequencing, EML4-ALK variant (prognostic, research), TP53 co-mutation (worse outcome), Brain MRI at diagnosis and during follow-up, Lipids, weight and mood on lorlatinib.

Scans and tests linked to this cancer: Comprehensive genomic profiling, Liquid biopsy (ctDNA).

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

The treatments I may be offered

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.

Answers and next steps

Saved in this browser
What I was told
Agreed next steps, dates and who to call