June 2012, Vol 1, No 2
Crizotinib Miracle: A Nursing PerspectiveLung Cancer
For every nurse there is a patient who you will never forget; the details of that story will not blur over time. In the developing era of personalized medicine, there is that 1 patient whose story I will not easily forget. It is the story of a 24-year-old male medical student who presented for initial consultation the same week that crizotinib was approved by the FDA for the treatment of anaplastic lymphoma kinase (ALK)-positive non–small cell lung cancer.
This young never-smoker was blissfully unaware of the recent advances in identifying the echinoderm microtubule-associated protein-like 4 (EML4)-ALK oncogene and the associated response to crizotinib. Upon initial evaluation, his tissue was sent for epidermal growth factor receptor and EML4-ALK testing, but due to the urgent nature of his symptoms, the decision was made to start standard platinum doublet chemotherapy. This is when I first met him – he was sitting in the chemo chair waiting for treatment to start.
He was quickly becoming symptomatic and was admitted to the hospital that day for evaluation. Over the course of the next couple of days he acutely developed a pericardial effusion that tamponaded, requiring emergent bedside pericardiocentesis. He proceeded to develop pulmonary emboli, atrial fibrillation, and pleural effusions requiring bilateral chest tubes. The second day he was in the ICU we received the news that his tumor was ALK positive. He was too sick to understand the news, and his family was too scared to understand the possible utility of this information.
Our patient assistance team worked feverishly with the pharmaceutical company and his insurance company since the drug was brand new. Twentyfour hours later he was taking crizotinib. His response was immediate and miraculous. He was discharged home 20 days later; he walked out of the hospital without any assistance or medical equipment.
Within 1 month of leaving the hospital he had resumed his normal activities of weekend outings and visiting his friends from med school. I remember the day he called the office to inquire whether he was allowed to have a beer, a once typical social activity for a 24-year-old student. We all smiled with relief, knowing that without crizotinib the outcome would not have been the same. He continues to do well and has become actively involved in educating people about lung cancer and crizotinib. Speaking to the public has given him a purpose and focus while he decides whether to continue with medical school.
As a nurse practitioner, being able to witness the lifealtering effects of crizotinib reminds me of the progress that is being made each day in cancer research. We hope that these advances in genomic testing and targeted agents continue to provide patients not only with individualized care but with increased treatment options.
Molecular tests have proliferated over the past decade, bringing the precision of genomics into reality in the clinic, but the payment system for nucleic acid–based tests has been unchanging and primitive. This unfortunate state of affairs has limited the ability of payers to encourage (or control) the use of genomic [ Read More ]
To receive credit, complete the posttest at www.mlicme.org/P11077.html. Until recently, cancer treatment relied solely on histologic diagnosis for determining systemic therapy. Aside from considerations related to a patient’s underlying comorbidities and performance status, there was minimal deviation from an organ-of-origin–based treatment strategy. This relatively primitive understanding of malignancy failed [ Read More ]