How to maximize clinical benefits for patients with ALK-positive non-small cell lung cancer

Nicolas Girard, MD, PhD, of Hospital Louis Pradel, Claude Bernard University, Lyon, France, discusses how to maximize clinical benefits for patients with ALK-positive non-small cell lung cancer (NSCLC), which is a rare subset of NSCLC. ALK arrangements predict the efficacy of treatment with certain tyrosine kinase inhibitors (TKI). There are several TKIs available for patients, including crizotinib, alectinib and ceritinib as well as additional third generation ALK tyrosine kinase inhibitors. Crizotinib is the current standard of care for first-line treatment both in the ESMO and NCCN guidelines. Data comparing crizotinib and chemotherapy in the first-line setting show clear benefits in terms of response rate and progression-free survival (PFS). At WCLC 2016, Dr Girard discussed how to maximize treatment benefits. It is known that in ALK-positive lung cancer, brain metastasis is frequent and a hallmark of the disease. Dr Girard, mentions that up to 70% of patients will ultimately develop brain metastases. However, despite this, overall survival is very high and higher than that seen in the global lung cancer population. Dr Girard explains treatment strategies where progressing lesions are treated locally while the patient continues to receive treatment with crizotinib. By continuing crizotinib treatment beyond progression, the clinician can increase the duration of treatment and maximise the benefits of crizotinib. Once the patient develops systemic progression, it becomes necessary to move to another ALK TKI, to alectinib and ceritinib as per ESMO and NCCN recommendations. By sequential use of ALK TKIs, it becomes possible to achieve a combined progression free survival (PFS) of 18 months and a median overall survival (OS) of 50 months. Dr Girard finishes by stating that progress is happening quickly with more and more data presented on the use of the different ALK TKIs and the evolving treatment strategies. He also states the need of precision medicine at the time of diagnosis but also throughout the patient management journey. Recorded at the 2016 World Congress of Lung Cancer (WCLC) of the International Association for the Study of Lung Cancer (IASLC) in Vienna, Austria.
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