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Dr. Neal Debates Whether Alectinib Will Become the Standard Frontline Therapy for ALK+ NSCLC

Joel Neal, MD
Published: Wednesday, Aug 09, 2017



Joel Neal, MD, an assistant professor of medicine and oncology at Stanford Medicine, discusses whether, if approved by the FDA, alectinib (Alecensa) will become the frontline standard of care for patients with ALK-positive non–small cell lung cancer (NSCLC).

The current FDA approval for alectinib is for patients who are refractory to crizotinib (Xalkori) or intolerant of crizotinib, Neal explains. His personal preference is that, though the data are compelling with alectinib, his main goal is that the progression-free survival rates are additive. It may not matter that starting with alectinib or ceritinib would outperform the sequential treatment.

However, 1 of the big differences is that that the second-generation drugs are able to more effectively penetrate the brain, as patients with ALK-positive NSCLC often develop brain metastases. In the phase III ALEX trial, results showed that more than half of patients on ceritinib (Zykadia) within 2 years developed brain metastases, and only about 10% on alectinib developed brain metastases. Being on a stable dose of a tolerated therapy without developing new brain metastases that need to be managed is a good thing for patients, he concludes.


Joel Neal, MD, an assistant professor of medicine and oncology at Stanford Medicine, discusses whether, if approved by the FDA, alectinib (Alecensa) will become the frontline standard of care for patients with ALK-positive non–small cell lung cancer (NSCLC).

The current FDA approval for alectinib is for patients who are refractory to crizotinib (Xalkori) or intolerant of crizotinib, Neal explains. His personal preference is that, though the data are compelling with alectinib, his main goal is that the progression-free survival rates are additive. It may not matter that starting with alectinib or ceritinib would outperform the sequential treatment.

However, 1 of the big differences is that that the second-generation drugs are able to more effectively penetrate the brain, as patients with ALK-positive NSCLC often develop brain metastases. In the phase III ALEX trial, results showed that more than half of patients on ceritinib (Zykadia) within 2 years developed brain metastases, and only about 10% on alectinib developed brain metastases. Being on a stable dose of a tolerated therapy without developing new brain metastases that need to be managed is a good thing for patients, he concludes.

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