Report from the World Conference on Lung Cancer (WCLC)
Cheryl Ho, MD FRCPC, Medical Oncologist, BC Cancer, and Clinical Associate Professor, UBC;
and Alexandra Pender MB BChir MRCP PhD, BC Cancer
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Commentary: Targeting ALK in patients with ALKpositive
lung cancer results in high tumour response rates
and prolonged survival. Progression on crizotinib is often
due to development of brain metastases resulating from
poor central nervous system (CNS) drug penetration.
Crizotinib is the first anaplastic lymphoma kinase
(ALK) inhibitor to demonstrate an improvement in
progression-free survival (PFS) over platinum-based
chemotherapy in advanced ALK-positive non-small
cell lung cancer (NSCLC) patients.
Alectinib, a central nervous system (CNS)-penetrant
ALK tyrosine kinase inhibitor (TKI), has greater efficacy
in treatment-naive ALK-positive NSCLC than
crizotinib.
What this study showed
Brigatinib is more effective than crizotinib in treatment-
naive ALK-positive NSCLC, with greatest benefit
seen thus far in patients with brain metastases at
enrolment.
Next steps
Brigatinib is another option for first-line treatment of
ALK positive NSCLC with an acceptable toxicity profile.
The optimal sequencing of ALK inhibitors and
the most efficacious first-line inhibitor are yet to be
confirmed.
