IN ALK+ NSCLC   A LOT CAN HAPPEN IN A MONTH     CAN CHECKING MONTHLY FOR SYMPTOMS HELP YOU DETECT PROGRESSION EARLIER? Click here to register for updates.     RECOGNIZE PROGRESSION • Prior to 2011, there were no targeted therapies available to treat patients with ALK+ NSCLC1-3 • Inevitably, patients develop resistance to currently available ALK inhibitor therapy and typically progress after 10 months4-6 • Common sites of disease progression in patients treated with an ALK inhibitor include the CNS, lung, and liver6     IDENTIFY SYMPTOMS • Symptoms, including cough, dyspnea, fatigue, pain, hemoptysis, and anorexia, can serve as signals of progression7,8 • Compared to patients with other tumor types, patients with NSCLC are at higher risk for developing CNS metastases9   — Symptoms of CNS metastases include headaches, seizures, cognitive impairment, and neurological deficits10   — Patients with ALK+ NSCLC may develop CNS metastases due to treatment resistance11 INTERVENE NOW • By assessing patient symptoms monthly during routine physical exams, progression may be detected earlier7 • According to RECIST guidelines, a CT scan may be the best method for monitoring response to therapy12 • Early detection of CNS metastases by a cranial CT or MRI—even before symptoms develop—may improve prognosis13     ALK, anaplastic lymphoma kinase; CNS, central nervous system; CT, computed tomography; MRI, magnetic resonance imaging; NSCLC, non-small cell lung cancer; RECIST, Response Evaluation Criteria in Solid Tumors. Novartis Oncology is committed to advancing research into the ALK pathway to help find new options for patients with lung cancer.       Click here to register for updates.     References: 1. XALKORI® (crizotinib) Prescribing Information. New York, NY: Pfizer Labs; October 2013. 2. Sasaki T, Rodig SJ, Chirieac LR, Jänne PA. The biology and treatment of EML4-ALK non-small cell lung cancer. Eur J Cancer. 2010;46(10):1773-1780. 3. US Food and Drug Administration. FDA approves Xalkori with companion diagnostic for a type of late-stage lung cancer. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm269856.htm. Released August 26, 2011. Accessed November 5, 2013. 4. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Non-Small Cell Lung Cancer V.2.2014. © National Comprehensive Cancer Network, Inc 2013. All rights reserved. Accessed November 4, 2013. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc. 5. Katayama R, Shaw AT, Khan TM, et al. Mechanisms of acquired crizotinib resistance in ALK-rearranged lung cancers. Sci Transl Med. 2012;4(120):1-12. doi:10.1126/scitranslmed.3003316. 6. Camidge DR, Bang Y-J, Kwak EL, et al. Activity and safety of crizotinib in patients with ALK-positive non-small-cell lung cancer: updated results from a phase 1 study. Lancet Oncol. 2012;13(10):1011-1019. 7. de Marinis F, Pereira JR, Fossella F, et al. Lung cancer symptom scale outcomes in relation to standard efficacy measures. J Thorac Oncol. 2008;3(1):30-36. 8. Hollen PJ, Gralla RJ, Kris MG, et al. Measurement of quality of life in patients with lung cancer in multicenter trials of new therapies. Cancer. 1994;73(8):2087-2098. 9. Schouten LJ, Rutten J, Huveneers HAM, et al. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer. 2002;94(10):2698-2705. 10. Fokas E, Steinbach JP, Rödel C. Biology of brain metastases and novel targeted therapies: time to translate the research. Biochim Biophys Acta. 2013;1835(1):61-75. 11. West H, Oxnard GR, Doebele RC. Acquired resistance to targeted therapies in advanced non-small cell lung cancer: new strategies and new agents. Am Soc Clin Oncol Educ Book. 2013:e272-e278. doi: E10.1200/EdBook_AM.2013.33.e272. 12. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228-247. 13. Sánchez de Cos J, Sojo González MA, Montero MV, et al. Non-small cell lung cancer and silent brain metastasis. Survival and prognostic factors. Lung Cancer. 2009;63(1):140-145. 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