Canadian perspectives: update on inhibition of ALK-positive tumours in advanced non-small-cell lung cancer.

ABSTRACT: Background:Inhibition of the anaplastic lymphoma kinase (alk) oncogenic driver in advanced non-small-cell lung carcinoma (nsclc) improves survival. In 2015, Canadian thoracic oncology specialists published a consensus guideline about the identification and treatment of ALK-positive patients, recommending use of the alk inhibitor crizotinib in the first line. New scientific literature warrants a consensus update. Methods:Clinical trials of alk inhibitor were reviewed to assess benefits, risks, and implications relative to current Canadian guidance in patients with ALK-positive nsclc. Results:Randomized phase iii trials have demonstrated clinical benefit for single-agent alectinib and ceritinib used in treatment-naïve patients and as second-line therapy after crizotinib. Phase ii trials have demonstrated activity for single-agent brigatinib and lorlatinib in further lines of therapy. Improved responses in brain metastases were observed for all second- and next/third-generation alk tyrosine kinase inhibitors in patients progressing on crizotinib. Canadian recommendations are therefore revised as follows:? Patients with advanced nonsquamous nsclc have to be tested for the presence of an ALK rearrangement.? Treatment-naïve patients with ALK-positive disease should initially be offered single-agent alectinib or ceritinib, or both sequentially.? Crizotinib-refractory patients should be treated with single-agent alectinib or ceritinib, or both sequentially.? Further treatments could include single-agent brigatinib or lorlatinib, or both sequentially.? Patients progressing on alk tyrosine kinase inhibitors should be considered for pemetrexed-based chemotherapy.? Other systemic therapies should be exhausted before immunotherapy is considered. Summary:Multiple lines of alk inhibition are now recommended for patients with advanced nsclc with an ALK rearrangement.

SUBMITTER: Melosky B 

PROVIDER: S-EPMC6209554 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature