Dr. Rotow on Brigatinib Safety Profile in ALK+ NSCLC

Julia Rotow, MD, medical oncologist, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, discusses the safety profile of brigatinib (Alunbrig) in ALK-positive non­—small cell lung cancer (NSCLC).

In 2017, the FDA announced accelerated approval of brigatinib for patients with metastatic ALK-positive NSCLC who are resistant to prior crizotinib.

Brigatinib has shown similar toxicity to available ALK TKIs, including gastrointestinal adverse events, explains Rotow. Other toxicities such as elevated blood pressure, creatine phosphokinase, and lipase appear to be more specific to brigatinib, she continues.

Importantly, a pulmonary toxicity syndrome may develop in some patients treated with brigatinib within the first week or so of therapy. This syndrome can present with shortness of breath or infiltrates on lung imaging, Rotow says.

A dose-escalation regimen with brigatinib may mitigate this toxicity, concludes Rotow. Patients should have a 1-week 90 mg lead-dose of the drug, with an increased 180 mg dose given if initial therapy is well tolerated.