Dr. Stinchcombe Discusses Differences in Toxicity Profiles Among ALK Inhibitors in NSCLC

Thomas E. Stinchcombe, MD, professor of medicine, Duke Cancer Institute, discusses the differences in toxicity profiles between brigatinib (Alunbrig) and alectinib (Alecensa) in ALK-positive non—small cell lung cancer (NSCLC).

The toxicities with alectinib are fairly mild, although there may be subtle increases in liver function tests and creatine phosphokinase (CPK) levels, says Stinchcombe. Moreover, some patients may experience mild fatigue. With brigatinib, there can be some episodes of hypertension and early-onset pulmonary symptoms that physicians should be cautious of. Because of this, the drug is given 90 mg daily for the first week and then escalated up to 180 mg.

However, many of these events occur within the first 1 or 2 weeks of therapy, adds Stinchcombe. Patients can also experience an increase in CPK. Both agents have very similar toxicity profiles with the exception of pulmonary events, which are unique to brigatinib.