Hi @loriwt, I have been taking alectinib for the ALK mutation for 45 months now. Some people get longer, but most people get much less time on that drug. I've had side effects, and a few scares along the way, but it is still protecting me from the cancer. I know that one day, my cancer will mutate more and outsmart the drugs.
At that time,
- we'll do a fresh biomarker test to determine what's driving the new cancer. Is it still ALK, or something different?
- we'll need to see if there is an approved drug that matches whatever new mutation I have grown.
- we'll look to clinical trials for new drugs that may help. (Go Research!!)
- we'll use chemo as a backup plan. Of course, I'd rather find a fancy new smart drug.
Each of these items start with "we'll", because I need to trust in my team, and know that I have their support and knowledge when the time comes to make this decision. That gives me comfort. I'm not alone.

For RET, there are two approved therapies on the market, but they may be specific to certain variants of RET, your doctor will know if the other is a good fit for you. After the therapies are no longer working, some patients can look to immunotherapy and/or chemo. Of course, we're always hopeful that some fancy new drug will be in clinical trials or even approved before we need them.