Dr. Liu on Navigating the Frontline Treatment of ALK+ NSCLC

Stephen Liu, MD, associate professor of medicine, Division of Hematology and Oncology, Georgetown University Medical Center, discusses the frontline treatment of ALK-positive non—small cell lung cancer (NSCLC).

There are 3 FDA-approved therapies for the treatment of ALK-positive NSCLC—–crizotinib (Xalkori), ceritinib (Zykadia), and alectinib (Alecensa). Brigatinib (Alunbrig), though not yet FDA approved, is recommended as a category 1 therapy by the NCCN. Of the approved agents, Liu recommends starting a patient on alectinib.

If brigatinib is FDA approved, choosing between alectinib and brigatinib will be more challenging. In that case, insurance coverage and cost may play more of a role in therapy selection, says Liu. The 2 agents also have slightly different toxicity profiles, so physicians can tailor the toxicity profile towards individual patients. As the data mature between the ALEX trial and the ALTA-1L trials, it will give physicians a better idea of which drug to pursue. The biggest factor that will likely influence physicians is the difference in resistance, Liu concludes.