Dr. Saxena on Treatment Options in ALK+ NSCLC

Ashish Saxena, MD, PhD, assistant attending physician, NewYork-Presbyterian Hospital, assistant professor of medicine, Weill Cornell Medical College, discusses the treatment landscape of ALK-positive non—small cell lung cancer (NSCLC).

Currently, ALK inhibitors are the frontline standard of care in patients with ALK-positive NSCLC, says Saxena. In 2011, crizotinib (Xalkori) became the first TKI approved for ALK-positive NSCLC. Other TKIs including ceritinib (Zykadia) and alectinib (Alecensa) were approved in 2017. Brigatinib (Alunbrig) is not currently approved in the first-line setting. However, the agent was granted accelerated approval in 2017 to treat patients with ALK-positive NSCLC who progressed on or are intolerant of crizotinib.

Updated results of the phase III ALEX trial demonstrated superior progression-free survival (PFS) and overall survival with alectinib compared with crizotinib for patients with previously untreated, advanced ALK-positive NSCLC. Moreover, brigatinib demonstrated an improvement in PFS versus crizotinib in patients with treatment-naïve ALK-positive NSCLC in the phase III ALTA-1L trial.

As such, alectinib is the preferred frontline therapy in patients with ALK-positive disease, says Saxena.

In 2018, lorlatinib (Lorbrena) was approved for patients with ALK-positive metastatic NSCLC who progressed on crizotinib and at least one other ALK inhibitor, or who progressed on first-line alectinib or ceritinib, concludes Saxena.