Support for this educational program provided by Amgen, AstraZeneca, Blueprint Medicines, Bristol Myers Squibb, Genentech, Lilly Oncology, Merck, Novartis and Pfizer.
What is a ROS1-positive cancer?
Errors in the ROS-1 gene are one type of lung cancer biomarker. When the ROS1 gene fuses together with part of another gene and causes lung cancer, a patient is said to be ROS1-positive. This gene change is called a ROS1 fusion, or ROS1 rearrangement, because it changes the ROS1 gene in a way that causes uncontrolled cell growth and cancer. The ROS1 gene can fuse with many different partners. The most common fusion in lung cancer is the CD74 gene. The targeted therapy a ROS1-positive patient receives is the same regardless of the very specific type of ROS1 rearrangement they may have.
How do you know if you have ROS1-positive lung cancer?
To determine if lung cancer is ROS1-positive, tumor tissue testing, or blood testing will need to be done. There are several different types of tests that doctors use, including FISH (fluorescence in situ hybridization) analysis, which looks at changes in the chromosomes through tissue under a microscope. Next-generation sequencing (NGS), also called comprehensive biomarker testing, is another testing method. NGS is completed by placing tumor tissue into a machine that looks for many possible biomarkers at one time. There may be some situations where a patient can’t undergo the biopsy needed gather enough tissue to perform NGS, so a liquid biopsy is recommended instead. A liquid biopsy can look for certain biomarkers in a patient’s blood. Talk to your doctor to make sure one of these tests was performed.
Your doctor may perform several of these tests at the same time to help confirm results.
Learn more about the different types of biomarker tests.
Who is likely to have ROS1-positive lung cancer?
The ROS1 gene is altered in about 1-2% of patients with lung cancer and generally appears in adenocarcinoma non-small cell lung cancer. Patients who are ROS1-positive tend to be younger than the average patient with lung cancer and have little to no smoking history.
What are the treatment options for someone with ROS1-positive cancer?
Knowing if you have ROS1-positive lung cancer is important no matter your stage of lung cancer. However, it has the most treatment implications for advanced-stage patients with lung cancer.
Much is being studied about ROS1, and the treatment strategy may differ between patients. The treatment a patient receives and the order in which the treatment is given depends on the type of fusion present, how well the patient tolerates the medication and if the cancer has spread to the brain. Below is a high-level overview of treatment options for ROS1 lung cancer, but your specific treatment plan may vary.
First-line Treatment
Patients with advanced-stage ROS1-positive lung cancer will likely be prescribed a pill called a ROS1 tyrosine kinase inhibitor (TKI) or ROS1 inhibitor. The current FDA-approved options are crizotinib (Xalkori), entrectinib (Rozlytrek) and repotrectinib (Augtyro).
Second-line Treatment
In time, the cancer is likely to evolve, and the ROS1-inhibitor may stop working. Some patients will develop a new resistance mutation (a gene change that causes the cancer to stop responding to a certain drug). Your doctor may want to do a tissue or liquid biopsy to check for this. Once a patient develops resistance to a ROS1-inhibitor, your doctor may recommend a clinical trial, another ROS1-inhibitor, or another targeted therapy that is considered off-label. This means it is approved to treat a different biomarker like ALK but is not approved to treat ROS1.
Third-line Treatment
If the cancer continues to grow after second-line treatment, the next option would include a clinical trial, chemotherapy with or without a ROS1 inhibitor, or chemotherapy with or without immunotherapy.
Brain Metastasis
It is common for ROS1-positive lung cancer to spread to the brain, called metastasis. Cancer that has spread to the brain may be treated with ROS1 inhibitors that can reach the brain and stereotactic radiosurgery (SRS), a type of brain radiation.
Work with your doctor to discuss your goals and options each time you have to make a treatment decision. The three big questions to ask are:
- What is the goal of this treatment?
- What are the potential side effects?
- What other options do I have?
Research is happening at a rapid pace and your doctor should be up to date on the recommendations for your specific type of lung cancer. If you don’t feel comfortable with the answers you are receiving, do not hesitate to seek out a second opinion.
Where can I get support?
- Join our free Lung Cancer Survivors online support community on Inspire where there is a large community of ROS1-positive lung cancer patients.
- Request a ROS1-positive patient or caregiver mentor
- Call our freeLung HelpLine to talk to a healthcare professional.
- Connect with the ROS1ders Patient Group
- It is important to work closely with your physicians to help monitor your medication side effects. Ask about connecting with a supportive/palliative care doctor at the beginning of your treatment to help ensure your side effects are well managed.
Lung cancer research can move at a rapid pace. Always speak with your doctor about the most up-to-date treatment guidelines.
Page last updated: October 2, 2024
