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

Stephen Liu, MD
Published: Friday, Nov 09, 2018



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.


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.

View Conference Coverage
Online CME Activities
TitleExpiration DateCME Credits
Community Practice Connections™: Oncology Best Practice™ Decision Points in Advanced NSCLC: Assessing Treatment Options Beyond Disease ProgressionNov 30, 20181.0
Community Practice Connections™: Precision Medicine for Community Oncologists: Assessing the Role of Tumor-Testing Technologies in Cancer CareNov 30, 20181.0
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