Joseph Leach, MD, medical oncologist at Minnesota Oncology, discusses the use of brigatinib (Alunbrig) in ALK-positive non–small cell lung cancer (NSCLC).
Brigatinib is a potent ALK inhibitor that was approved by the FDA for use in patients who have progressed on first-line crizotinib (Xalkori). Now, there are phase III data comparing brigatinib with crizotinib in the frontline setting. These data showed that brigatinib conferred a greater progression-free survival advantage compared with crizotinib. Moreover, the data show that brigatinib has more potent activity than alectinib (Alecensa) against more secondary mutations like G1202R, which is commonly acquired after exposure to a second-generation ALK inhibitor.
Now that brigatinib has shown a PFS benefit in both the frontline and second-line settings, it is unclear in which setting it is best used, says Leach. Despite the data showing the superiority of brigatinib to crizotinib in the frontline setting, the agent has yet to receive a frontline approval. Until an approval is granted, alectinib is likely to remain the frontline standard of care, says Leach. Since brigatinib has been shown to induce a response of approximately 40% in patients who progressed on second-generation ALK inhibitors, it may be a valuable second-line option, he concludes.