Leena Gandhi, MD, PhD
Currently available as a second-line therapy for patients with ALK
-positive non–small cell lung cancer (NSCLC), alectinib’s (Alecensa) frontline potential is being explored in the ongoing phase III ALEX study (NCT02075840), which could transform first-line treatment for these patients.
-positive NSCLC, as well as novel agents emerging in the field.
OncLive: Can you provide an overview of where we are with sequencing ALK inhibitors for this patient population?
That's a great question. It is actually very up in the air right now because we are in the midst of ongoing trials that may establish a new first-line standard of care. This is with the alectinib versus crizotinib trials that have been reported out from Japan, and it’s still ongoing out in the United States. Alectinib is now a standard of care for first-line therapy in Japan and I suspect it will become so here as well—once the ALEX study reads out.
The second-line setting, therefore, also gets completely mixed up once that changes because everything will have to shift around. There are newer drugs that are not yet approved and will probably play a very important role in that space, as well.
What other recent advances have we seen with these ALK inhibitors?
The exciting things that we are still waiting to see are how good are the drugs brigatinib and lorlatinib, and what will they replace? They have the potential to become a first-line standard themselves, but there are also really important roles to be played for the second-line setting.
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