What is ROS1-positive lung cancer and how is it treated?

A ROS1-positive lung cancer, also known as a ROS1 rearrangement in lung cancer, refers to any lung cancer that tests positive for a fusion in the ROS1 gene. ROS1 rearrangements occur in approximately 1-2% of patients with non-small cell lung cancer (NSCLC). ROS1-positive lung cancer tends to be aggressive and can spread to the brain and the bones.

In this Hope With Answers℠ video, you will meet Lysa Buonanno, who is a lung cancer patient and very active advocate. Lysa asks Dr. Carbone about the new and exciting research that is helping to increase the ROS1 lung cancer survival rate.

ROS1-positive lung cancer occurs when a gene called ROS1 fuses with a nearby gene. This fusion causes the ROS1 gene to remain stuck in the “on” position. This “drives” abnormal cell growth, which is what cancer is. The ROS1 gene is a receptor tyrosine kinase, a cell surface receptor that has been shown not only to be a key regulator of normal cellular processes, but it also has a critical role in the development and progression of many types of cancer, including lung cancer.

ROS1 is an oncogene, like the ALK oncogene, and, in fact, is related to ALK. According to the National Cancer Institute, an oncogene is a gene that is, under normal circumstances, involved in cell growth, but becomes cancerous if a mutation occurs. Patients with a ROS1 rearrangement respond well to some of the same treatments that are used to treat ALK-positive lung cancer patients.

Dr. David Carbone, of the James Cancer Center at Ohio State University, says, “Immunotherapy has revolutionized lung cancer treatments for many patients.” However, patients with a ROS1 biomarker driving their cancer are less likely to benefit from immunotherapy than other lung cancer patients. Dr. Carbone recommends starting with ROS1 targeted therapies first. The idea is to continue those as long as they’re working.

In these videos, lung cancer patient and advocate, Lysa Buonanno, asks Dr. David Carone the questions important for those living with ALK-positive lung cancer. And, Dr. Carbone, who is a leading lung cancer expert, provides the answers.

Facts about ROS1-positive lung cancer patients

ROS1-positive lung cancer patients tend to be:

  • younger than average
  • test negative for other known lung cancer biomarkers such as EGFR and ALK
  • people who have never smoked or only smoked a little.

In addition, compared to other forms of lung cancer, a 2015 study found that:

  • The median age of people with ROS1-positive lung cancer was 50.5. (The median age for lung cancer, in general, is 70.)
  • ROS1-positive lung cancer was slightly more common in women, with 64.5 percent ROS1-positive lung cancer patients being female. (Lung cancer, in general, is slightly more common in men than in women.)

Testing for ROS1-positive lung cancer

Comprehensive biomarker testing can determine whether an ROS1 lung cancer mutation or another lung cancer mutation is present. If you receive a lung cancer diagnosis, the very first thing you should do is make sure your doctors have ordered comprehensive biomarker testing done on your lung cancer tumor. You should have this testing done and you should have the results before starting any treatment, including chemotherapy and/or immunotherapy.

NCI-Designated Comprehensive Cancer Centers and other academic centers are excellent choices for and have experience in comprehensive biomarker testing. You can also have the testing done by a commercial lab recommended by your physician.

Lung Cancer Testing FAQ

Where can I go for Comprehensive Biomarker Testing?

NCI-Designated Comprehensive Cancer Centers and other academic centers are excellent choices for and have experience in comprehensive biomarker testing. You can also have the testing done by a commercial lab recommended by your physician.

What’s involved with biomarker testing?

The comprehensive biomarker testing will involve a biopsy of your lung cancer. This biopsy will remove tissue, which will then be tested for its genetic makeup, or biomarkers. In most cases, tissue that is obtained from the original biopsy for diagnosing the lung cancer is used.

It is best to follow the current guidelines recommended by the The National Comprehensive Cancer Network (NCCN). The NCCN recommends that your tumor be tested for at least 8 different biomarkers. It is a good idea to request thorough biomarker testing from your physician, for the very best options for treatment. It is important to wait for all biopsy test results to be returned before starting a treatment.

Once the biomarker testing is complete, and ROS1-positive lung cancer determined, there are some good and effective treatment options available. If your lung cancer hasn’t yet spread and it’s in an early stage, you might be a candidate for surgery to have the lung cancer completely removed. If not, the lung cancer can be treated with a targeted therapy, which is commonly a pill, taken by mouth.

Effective targeted therapies for ROS1-positive lung cancer include:

    • Crizotinib
    • Lorlatinib
    • Entrectinib
    • Ceritinib

Clinical trials are sometimes great options for patients with ROS1-positive lung cancer. If you are accepted into a clinical trial, you will either receive an investigational drug or be randomized to receive the investigational drug or the best standard of care, depending on whether you are in a first-in-human trial or a later phase trial. (Best standard of care is the best treatment that physicians are offering patients with that cancer.)

In addition, the care that is included in the clinical trial will be covered financially by the trial sponsor, and you may receive a new treatment that might become a best option for you. There may also be additional expenses that might not be covered by the trial sponsor, so please carefully read the Informed Consent agreement. Discuss any concerns with a trial coordinator prior to making your decision.

How can I find a Clinical Trial?

Here are 2 ways to find clinical trials – working with your doctor, you might get a jump on a new and better treatment even before it is available to others. This can accelerate medical breakthroughs for everyone and helps to increase ROS1 positive lung cancer life expectancy.

Search for Clinical Trials with Antidote Match™

Antidote Match™ connects people with medical research studies, in the fastest and easiest way possible. All you need to do is answer a few questions, and they will find the right trials for you. You gain access to the latest medical developments and world-class care.

ClinicalTrials.gov image

Search for Clinical Trials at ClinicalTrials.gov

ClinicalTrials.gov is a database of privately and publicly funded clinical studies conducted around the world.

Immunotherapy has revolutionized lung cancer treatment overall, but not every lung cancer patient will benefit from it. In fact, patients with ROS1-positive lung cancer have much less probability of benefiting from immunotherapy than other biomarker driven lung cancers. Immunotherapy might be an option for ROS1-positive lung cancer patients after other options have been exhausted. But the approved targeted therapies for ROS1-positive lung cancer are the best choice for first line treatment.


More people are living with lung cancer.

Follow the hopeful stories of ROS1-positive lung cancer survivors: Lisa Goldman, Patty Watkins, Lysa Buonanno.


Learn more about targeted therapy

Targeted therapies are a form of personalized medicine that is bringing great hope to lung cancer patients.


New lung cancer research is saving more lives.

Stand with survivors and help fund lung cancer research. By donating to LCFA, you help to fund innovative new research in the field of lung cancer treatment.