Very Helpful Video
Thanks for the link-
Nice to see expert docs aware of the potential game changing importance of ALK+ superiority with brain mets.
Very interesting to see that there is a significant part of the expert community that still believes it may be advisable to use weaker drugs to buy time(even though the use of these results in mutational failures),
versus using your best drug first to avoid these in the first place.
Although comparative double-blind clinical studies would be necessary to absolutely determine which strategy yields the best OS, the logic of using your best drug first(probably 113)seems most compelling, and the group appeared to be right on the verge of acknowledging it.
God bless them for that lol.
Although we may never see those formal comparative studies, I think it will nevertheless become apparent over time, that, just as in the case of Pona in cml, using your best drug first enables you to avoid mutational failures that weaken pts, fosters the development of more virulent mutations than could develop otherwise, and, ultimately, shortens pts lives.
I believe the fallacy in saving your best drug till last is that practitioners believe mutations are going to develop in any case and you avoid the higher level(more difficult to treat) mutations from developing by using the weaker drugs first.
However, as in the case of Pona in cml, if 113 is truly a pan ALK inhibitor(at least with regard to ALK+ mutations) it's ability to totally shut down this route of tumor viability, should cause it to totally knock out this cancer before it gets the opportunity to access alternative mutational routes to survival.
When you consider how low the IC50 and IC90 values are for 113 in ALK+ compared to the achievable blood levels, this seems very likely the case.
So, thanks again for this video, because, with the help of a little bit more data(which should be available shortly), it shows that this group is almost there(i.e. almost ready to embrace the "best drug" paradigm), and with it the apparent superiority of 113 in ALK+ NSCLC!
AI
