ALK-positive NSCLC: Current landscape

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Published: 29 Apr 2019
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Dr Antonio Passaro and Prof Rafal Dziadziuszko

Dr Antonio Passaro chairs a discussion with Prof Rafal Dziadziuszko on the current landscape and latest developments in ALK-positive non-small-cell lung cancer (NSCLC).

In this video, Prof Dziadziuszko outlines the current guidelines for patients with ALK-positive NSCLC; in which first-line treatments should involve the use of ALK inhibitors - as these have demonstrated improved progression-free survival (PFS) and quality of life compared to using traditional chemotherapy.

He also describes the historic use of fluorescent in-situ hybridisation (FISH) to identify ALK-positive translocations; however, due to its inefficiency, immunohistochemistry and next-generation sequencing are now the preferred methods of diagnosis.

For the first-line setting, Prof Dziadziuszko emphasises the importance of considering the toxicity and efficacy profiles of each inhibitor (both within the brain and in systemic regions) for the treatment of ALK-positive NSCLC.

He also anticipates that the next generation ALK inhibitors (such as alectinib, brigatinib, lorlatinib and ensartinib) will improve patient outcomes.

For the second-line setting, the use of stereotactic radiation combined with the continued use of the original ALK inhibitor used in the first-line setting should be considered for these patients. However, there have been encouraging data that support the use of third-generation ALK inhibitors (e.g. brigatinib or lorlatinib) for patients who fail the standard-of-care drug, crizotinib.

Prof Dziadziuszko describes the success of alectinib by improving PFS; as well as decreasing CNS progression during the phase III ALEX trial.

Prof Dziadziuszko concludes the discussion by highlighting the importance of evaluating CNS progression and toxicity when using ALK inhibitors -stating that the toxicity profile of alectinib is favourable.

New developments and guidelines about ALK-positive NSCLC
Diagnostics
ALK-positive NSCLC treatment options in the first-line setting
ALK-positive NSCLC treatment options in the second-line setting
Highlights from the ALEX clinical trial study

 

This programme has been supported by Roche.