Dr. Rotow on First-Line Brigatinib Versus Crizotinib in ALK+ NSCLC

Julia Rotow, MD, medical oncologist, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, discusses the utility of brigatinib (Alunbrig) versus crizotinib (Xalkori) for the first-line treatment of patients with ALK-positive non—small cell lung cancer (NSCLC).

The phase III ALTA-1L trial randomized 275 ALK inhibitor—naïve patients with ALK-positive disease to brigatinib or crizotinib (Xalkori), says Rotow. The trial design was similar to that of the phase III ALEX trial, which randomized patients to alectinib (Alecensa) or crizotinib in the same setting.

Initial results from ALTA-1L demonstrated improved progression-free survival (PFS) with brigatinib compared with crizotinib. Recently, updated findings from the trial showed continued PFS benefit at 2 years, as well as an improved objective response rate with brigatinib versus crizotinib.

In April 2017, the FDA granted an accelerated approval to brigatinib for the treatment of patients with ALK-positive NSCLC who progressed on or are intolerant of crizotinib. (Xalkori).

Regulatory approval of first-line brigatinib may be contingent on long-term follow-up and overall survival data; however, the results that have been reported to date suggest brigatinib will be added to the armamentarium as another option for ALK-positive patients, concludes Rotow.