Dr. Xia on the Frontline Treatment Landscape of ALK-Positive NSCLC

Bing Xia, MD, assistant professor of clinical medicine, Keck School of Medicine, University of Southern California, discusses the frontline treatment landscape of ALK-positive non—small cell lung cancer (NSCLC).

Crizotinib (Xalkori) has historically been the ALK inhibitor that's been used in the frontline setting, says Xia. However, now there are data supporting the use of alectinib (Alecensa), brigatinib (Alunbrig), and ceritinib (Zykadia) in the frontline setting. Brigatinib is not currently FDA approved for treatment-naïve patients who harbor an ALK rearrangement, but there are convincing data that show that brigatinib is effective in that setting, explains Xia. Therefore, brigatinib has the potential to be used as frontline therapy off-label.

There is also lorlatinib (Lorbrena), which is a newer ALK inhibitor. Data show that not only is this ALK inhibitor effective in the frontline setting, but it's FDA approved for use in patients who have received crizotinib and 1 other ALK inhibitor, or a second-generation ALK inhibitor. Therefore, it does have a place in patients who have developed resistance to alectinib, brigatinib, or ceritinib, concludes Xia.