Treatment Regimen for Patients With ALK+ Non-Small Cell Lung Cancer - Episode 3
Jonathan W. Riess, MD, MS:The factors I consider in choosing second-line therapy include, and somewhat differ between, whether the patient was previously on crizotinib or were they on alectinib. So, previously, before the approval of alectinib as first-line treatment with crizotinib, the pattern of metastatic disease would play a role to some extent. So, for example, if there was one place of metastatic disease that was progressing, we would call that oligoprogression.
Oftentimes, I would think about giving focused radiations to that area and continuing crizotinib. Now I’ve done that a lot less with alectinib and brigatinib being approved for second-line treatment. But that is an option to consider, particularly for oligoprogression. If a patient’s more symptomatic or there are other areas of progression, I do think about switching to alectinib or brigatinib, and that’s clearly an indication for changing treatment from crizotinib to a next-generation ALK TKI. And often those patients can re-respond and have excellent responses to alectinib and brigatinib, including in the CNS where these drugs get excellent penetration across the bloodbrain barrier. They can often have intracranial responses. So, another thing that I’ve done to help manage these patients is if the patients have asymptomatic brain metastases, I often do not use whole brain radiotherapy and often move to these ALK inhibitors. They have excellent blood–brain barrier penetration and excellent intracranial responses.
Transcript edited for clarity.
CASE:ALK+ NonSmall Cell Lung Cancer