Robert C. Doebele, MD, PhD:As we think about treatment forALK-positive nonsmall cell lung cancer, we’ve really seen a shift in how we treat these patients. Years ago, we were using crizotinib as first-line therapy, and then 1 of the next-generation inhibitors as second-line therapy. That’s really now been supplanted by alectinib or brigatinib as the first-line ALK inhibitor option.
As we mentioned, brigatinib can be used post alectinib if your patients have been receiving alectinib in the first-line setting. There’s now an FDA approval for lorlatinib as treatment post alectinib. I think where we’re going next is thinking about combination therapies for patients.
There is still at least 1 other ALK inhibitor in development: ensartinib. It’s not clear where that would fit into the treatment paradigm, because it’s not clear that it has any usual properties compared with some of the other drugs that we discussed today.
I do think that testing following treatment is going to help us better understand where we need to go next, in terms of therapeutic options for our patients. I think we’ve become very good at treating resistance mutations, but we’ve not been very successful in coming up with treatment paradigms for patients who don’t have resistance mutations and who have bypass signaling.
Transcript edited for clarity.
Case: A 53-Year-Old Woman WithALK-Rearranged NSCLC
A 53-year-old woman presented with dyspnea, persistent cough with bloody sputum, and intermittent pain in right side of her chest
Relevant PMH:
Nonsmoker, had childhood exposure to second-hand smoke
No history or presence of pneumonia or bronchitis
No history of diabetes, cardiovascular disease, or renal disease
PE: lungs, clear; no palpable masses or visible lesions; patient is of average height and weight, appears physically fit
Diagnostic workup:
Chest X-Ray: revealed multiple small solid lesions in right lung
CT with contrast chest/abdomen/pelvis: several hyperattenuated tumors in right lung