Dr Brown on the NCCN Guideline Inclusion of Brigatinib for NF2-Related Schwannomatosis

“Now I can go to my patients and say, ‘Look, this is now gold standard treatment.”

Rebecca Brown, MD, a neuro-oncologist at the University of Alabama at Birmingham, discussed how the inclusion of the TKI, brigatinib (Alunbrig), in the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for Central Nervous System Cancers as a recommended treatment for NF2-related schwannomatosis is changing disease management and the patient treatment experience.

Until now, Brown said that when she discussed brigatinib with patients, many viewed it as an experimental medication. With brigatinib now recommended by the NCCN, she can tell patients that it is gold-standard treatment.

Regarding clinical practice changes, achieving insurance approval for medications can often be a barrier, and community oncologists who do not specialize in managing NF2-related schwannomatosis may be unfamiliar with using brigatinib in this setting, Brown noted. This NCCN Guideline inclusion helps both oncologists and patients understand the potential benefits of the agent, she explained.

Brown said that for first-line NF2-related schwannomatosis management, she tends to be more aggressive about offering agents that have been shown to be effective in this disease, including brigatinib. Although she encourages clinical trial participation whenever possible, few trials exist for this rare disease. She also routinely discusses brigatinib’s availability and adverse effect (AE) profile with patients, noting elevations in certain laboratory values, which she monitors by assessing organ health with a complete metabolic panel and by checking blood counts. The AEs associated with brigatinib are usually lower grade and resemble those seen with other targeted therapies, such as gastrointestinal effects, fatigue, muscle soreness, and elevations in creatine kinase, she noted. After these discussions, most patients are willing to give the medication a try, Brown said. Her advice ultimately is to establish at least monthly check-ins early in the treatment course to ensure patients are not experiencing an excess of symptoms that go unreported, she concluded.