Camidge Tumor Markers: Blood Testing for Anticipation of ALK Positive Progression, Monitoring Ongoing Recurrence, and Tracking Treatment Effect. My Personal Experience.
Camidge Tumor Markers: Blood Testing for Anticipation of ALK Positive Progression, Monitoring Ongoing Recurrence, and Tracking Treatment Effect.
My Personal Experience: by Jeff Sturm
In August of 2017, Dr. Ross Camidge and his colleagues at University of Colorado published a research paper showing that certain blood-born tumor antigens from other cancers can be used as markers in ALK Positive lung cancer to signal impending and ongoing recurrence, as well as treatment response.
Baseline and On-Treatment Characteristics of Serum Tumor Markers in Stage IV Oncogene-Addicted Adenocarcinoma of the Lung
https://www.jto.org/article/S1556-0864(17)30680-9/pdf
Those of us lucky enough to have Dr. Camidge as part of our care team have been encouraged to follow these tumor markers. Colin Barton, founder of the ALK Positive Medical Committee, has been doing so since 2018. LabCorp currently tests for these markers as part of my regular blood draws, and insurance pays for it. Presumably other diagnostic and insurance companies will do the same. The four markers are CEA (carcinoembryonic antigen/colorectal cancer), CA125 (ovarian), CA19.9 (pancreatic), and CA27.29 (breast). University of Colorado’s data shows that increases in tumor markers for patients on oncogene-driven cancer therapy could occur up to 84 days in advance of radiographic changes of progression.
My local oncologist was quite skeptical about these tests when I asked for them, until I gave her a copy of Ross’s paper. We weren’t fully vigilant with the tests until March of 2023, when a small tumor showed up on a PET scan in my abdomen. Sure enough, two of the markers were slightly elevated. We biopsied and found progression on lorlatinib with I1171S and G1269R mutations. In particular the tumor marker CA27.29, which is the most ALK-sensitive, was out of normal range. CA27.29 was found by Camidge et al to be elevated in 94% of ALK patients at baseline. We irradiated that abdominal tumor, but the markers kept going up marginally throughout 2023, and according to Dr. Camidge, “there’s something going on”. And right on cue, in September a couple of lymph nodes in my chest started lighting up on a PET scan, while the tumor markers continued to inch up. Anticipating more serious progression, in November I traveled to University of Michigan for a hilar lymph node biopsy and organoid testing, which showed G1269A and G1202R mutations, and that NVL-655 had a good possibility of success with the hilar variant. In January 2024 we irradiated two small brain lesions that showed up in an MRI.
Shortly thereafter, also in January 2024, another pet scan showed peritoneal carcinomatosis; i.e. NSCLC metastasis in the abdominal wall, presumably ALK positive. At the same time, all of the four tumor markers were markedly elevated beyond normal range; CA27.29 spiked to 150 U/ml, and high normal is 38.6. I went on Brigatinib for a few weeks to bridge to the Nuvalent Phase II trial, then switched to NVL-655 on March 1 once the phase II trial opened. Since then, after reducing the dose of NVL-655 twice, and holding the dosing for two-week and three-week periods for elevated liver enzymes, I’ve been on 50mg for three weeks straight at this writing. The symptom improvement from February to July is significant, despite the long dosing breaks. Tumor markers are all down substantially now; CA27.29 is at 64.2, having peaked at 150 in February.
If used properly by your oncologist in conjunction with other testing methods, these tumor markers can aid with recurrence prediction, diagnosis, and treatment monitoring. There are some limitations within the first four weeks of treatment, and with central nervous system progression (see the University of Colorado paper). We used the marker information by increasing the frequency of scans, and by obtaining a timely biopsy in preparation for further anticipated metastasis. The markers are currently providing hopeful evidence that NVL-655 may be working, pending continuing liver tolerance at 50mg, ability to achieve consistent dosing, and radiographic confirmation.
Author: Jeffrey M. Sturm BS, MA, MBA
ALK Positive, Inc.
Member, Research Acceleration Committee
Member, Clinical Trials Committee
Member, Board of Directors