D. Ross Camidge, MD, PhD, director of thoracic oncology, University of Colorado, discusses optimal treatment strategies for patients with ALK-mutated non–small cell lung cancer.
D. Ross Camidge, MD, PhD, director of thoracic oncology, University of Colorado, discusses optimal treatment strategies for patients with ALK-mutated non—small cell lung cancer (NSCLC).
ALK-driven disease was a complex paradigm for some time due to the emergence of several targeted therapies, but Camidge says things have finally started to settle down in this space. Some patients are already being treated with frontline crizotinib (Xalkori); however, the question becomes, what should be their next line of therapy when they have progressive disease? The available ALK TKIs are comparable in this setting, he notes, but where they differ is in their associated median progression-free survival. In this case, brigatinib (Alunbrig) is the standout drug.
The second question that needs to be addressed is, what should these patients be treated with in the frontline setting? Camidge says that based on data from the phase III ALEX study, alectinib (Alecensa) is the optimal frontline agent. Brigatinib has shown some promising early data when compared with crizotinib in this setting, but with 10 months less follow-up than ALEX. Brigatinib and alectinib seem to have comparable hazard ratios, but these data can mature over time, he concludes.