<em>ALK</em>-Translocated Non-Small Cell Lung Cancer With Bone Metastases - Episode 2
Corey J. Langer, MD: Patients withALK-rearranged nonsmall cell phenotypically look very similar to patients with anEGFRmutation. By and large, they almost always have adenocarcinoma, a preponderance of never-smokers and remote former minimal smokers. Beyond that, the oncogenic driver that governs the behavior of the tumor is very different.EGFR-mutant tumors are highly sensitive to EGFR TKIs, such as gefitinib, erlotinib, and afatinib. Those drugs do not work inALK-rearranged tumors.
The first agent, approved roughly 5 or 6 years ago, was crizotinib, which actually was developed as a MET inhibitor. It was only incidentally discovered to be an ALK inhibitor. And that agent has stood the test of time and has shown superiority both in terms of response rate and progression-free survival compared with standard second-line chemotherapy. A little bit more recently, in one of the profile trials, single-agent crizotinib was clearly superior to a platinum/pemetrexed-based regimen in the frontline setting. At least until very recently, it has been the standard of care.
More recently, we’ve seen the emergence of second- and third-generation ALK TKIs, drugs that are developed specifically againstALK. Ceritinib was one of the first to be looked at in the second- and third-line settings and actually salvaged patients whose disease had responded and then progressed on crizotinib with progression-free intervals lasting 6, 7, 8, or 9 months. More recently, it has been compared with chemotherapy in the frontline setting and has shown a clear advantagemedian progression-free survival of 16 months or more compared with the standard 7 or 8 months. So, it, too, now has a formal approval in the frontline setting.
Transcript edited for clarity.