Dr. Paik on Resistance Mutations in NSCLC

Paul K. Paik, MD, clinical director, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, discusses resistance mutations in patients with non—small cell lung cancer (NSCLC).

A report published in the New England Journal of Medicine at the end of 2016 showed that a patient with ALK-positive lung cancer who had received crizotinib (Xalkori) developed disease progression. As is recommended, the tumor was biopsied and physicians found a particular alteration that should have predicted sensitivity to lorlatinib. The patient was treated with lorlatinib and had a very good response.

Over time, the patient developed another resistance mutation. The particular mutation predicted sensitivity to crizotinib, which was the drug the patient had originally progressed on. The patient received the drug and showed a dramatic response in the patient’s liver metastases. The use of preclinical data and importing it directly into clinical practice does work, states Paik.