General information about anaplastic lymphoma kinase positive (ALK+) advanced non-small cell lung cancer (NSCLC)
Further information about lung cancer in general and non-small cell lung cancer is available via the NHS website.
There are also a number of independent support groups for those living with ALK positive NSCLC.
The NHS and Cancer Research UK websites have been used as a resource for the information below, unless stated otherwise.
Lung cancer is one of the most common and serious types of cancer. Around 44,500 people are diagnosed with the condition every year in the UK. It accounts for ~13% of all cancers in the UK, being the third most common cancer after breast and prostate cancers.
Cancer that begins in the lungs is called primary lung cancer. Cancer that spreads to the lungs from another place in the body is known as secondary lung cancer. This page is about primary lung cancer.
There are two main types of primary lung cancer. These are classified by the type of cells in which the cancer starts. They are:
- small-cell lung cancer – a less common type that usually spreads faster than non-small-cell lung cancer
- non-small-cell lung cancer (NSCLC) – the most common type, accounting for more than 80% of cases; can be either squamous cell carcinoma, large-cell carcinoma or adenocarcinoma. Some of the adenocarcinomas are caused by genetic mutations*.
*A mutation is a change that occurs in our DNA sequence, either due to mistakes when the DNA is copied or as the result of environmental factors.
American Cancer Society Website, https://goo.gl/p2QzY
Adapted from Rosell et al. Lancet. 2016;387(10026):1354-1355.
The type of lung cancer a patient has determines which treatments are recommended.
Patients with ALK positive NSCLC have an abnormal form of the ALK gene. The ALK gene is located on chromosome 2. This abnormal ALK gene produces a protein known as a kinase that stimulates the growth of the cancer cells. As illustrated above, the ALK genetic mutation accounts for approximately 4% of the adenocarcinoma non-small cell lung cancers.
Lung cancer mainly affects older people. It's rare in people younger than 40, and the rates of lung cancer rise sharply with age. Lung cancer is most commonly diagnosed in people aged 70-74.
Although people who have never smoked can develop lung cancer, smoking is the main cause (accounting for over 85% of cases). This is because smoking involves regularly inhaling a number of different toxic substances.
However, the profile of an ALK positive NSCLC patient can be different compared to that of a typical lung cancer patient. ALK positive lung cancer tends to be more common in younger patients (40 to 50 years old) than NSCLC overall (typically aged 70–74 years). It tends to be more common in patients with adenocarcinomas. 70–80% of patients with ALK-positive NSCLC are “never smokers” vs 20–30% previous or current smokers.4 ALK positive lung cancer is often diagnosed at an advanced stage.
Symptoms of lung cancer develop as the condition progresses and there are usually no signs or symptoms in the early stages.
The main symptoms of lung cancer include:
- a cough that doesn’t go away after two or three weeks
- a long-standing cough that gets worse
- persistent chest infections
- coughing up blood
- an ache or pain when breathing or coughing
- persistent breathlessness
- persistent tiredness or lack of energy
- loss of appetite or unexplained weight loss
Less common symptoms of lung cancer include:
- changes in the appearance of your fingers, such as becoming more curved or their ends becoming larger (this is known as finger clubbing)
- a high temperature (fever) of 38°C (100.4F) or above
- difficulty swallowing or pain when swallowing
- a hoarse voice
- swelling of your face or neck
- persistent chest or shoulder pain
Treatment depends on the type of cancer, how far it's spread and how good a person’s general health is.
If the condition is diagnosed early and the cancerous cells are confined to a small area, surgery to remove the affected area of lung is usually recommended. If surgery is unsuitable due to general poor health, radiotherapy to destroy the cancerous cells may be recommended instead. If the cancer has spread too far for surgery or radiotherapy to be effective, chemotherapy is usually used. Depending on the specific type of cancer, other targeted medicines may be recommended.
- NHS UK https://www.nhs.uk/conditions/lung-cancer/. Accessed March 2019.
- Cancer Research UK https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/common-cancers-compared#heading-Zero. Accessed March 2019.
- ALUNBRIG Patient Information Leaflet
- IASLC atlas of ALK testing in lung cancer. https://www.iaslc.org/sites/default/files/wysiwyg-assets/alk_atlas_final_lo-res_09.23.13.pdf. Accessed March 2019.