Medical Oncology

ALK+

Questions discussed in this category

How would you approach first-line treatment in metastatic NSCLC for a patient with ALK-EML4 V3a/b variant and MSI-high status?

Both ALK and MSI-high status were noted on a liquid biopsy since there was not enough tissue available for molecular testing. Some reports suggest lo...

1 Answer available

How would you treat a patient with newly diagnosed ALK+ Stage IIIB non-small cell lung cancer (NSCLC)?

Would you recommend concurrent chemoradiation or targeted therapy with lorlatinib?

1 Answer available

Are you offering durvalumab to patients with Stage III NSCLC with known targeted mutations (ie ALK, EGFR, ROS1, BRAF) after completion of chemoradiation per PACIFIC?

2 Answers available

Would you offer a different ALK inhibitor to a patient receiving alectinib who had decompensation of liver function in the setting of preexisting cirrhosis?

1 Answer available

What is your preferred first line therapy in metastatic ALK+ NSCLC?

The CROWN, ALTA and ALEX trials showed improved efficacy with lorlatinib/brigatinib/alectinib vs crizotinib. How do you choose your first line therapy...

6 Answers available

How do you approach treatment for patients with ALK+ mNSCLC who have multifocal or leptomeningeal CNS progression while on first-line targeted therapy?

Would you test for resistance mutations in this setting, using blood-based sample if no progression outside CNS?

5 Answers available

How do you think about sequencing therapy for a patient with ALK+ metastatic NSCLC given the available options?

What is the current data regarding acquired resistance mutations for ALK? Should newer agents such as lorlatinib be reserved for later lines a...

3 Answers available

How do you manage ALK-inhibitor AEs which are low grade but significantly impact patient QOL over time?

Such as dysgeusia, headache, rash, fatigue, etc

4 Answers available

How would you treat a patient with metastatic NSCLC >50% PDL-1 positive AND an EGFR or ALK gene mutation/rearrangement in the first-line setting?

1st-line pembrolizumab is supposed to be used AFTER failure of appropriate targeted agents in this setting, but would you consider the reverse sequenc...

2 Answers available

Papers discussed in this category

The New England journal of medicine, 2015-10-22

Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer.

The New England journal of medicine, 2016-11-10

Pembrolizumab versus Chemotherapy for PD-L1-Positive Non-Small-Cell Lung Cancer.

J Thorac Oncol,

Upregulation of PD-L1 by EGFR Activation Mediates the Immune Escape in EGFR-Driven NSCLC: Implication for Optional Immune Targeted Therapy for NSCLC Patients with EGFR Mutation.

Clin. Cancer Res., 2015 May 27

Induction of PD-L1 Expression by the EML4-ALK Oncoprotein and Downstream Signaling Pathways in Non-Small Cell Lung Cancer.

Lancet (London, England), 2017-01-21

Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial.

Lancet (London, England), 2016-04-09

Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial.

The New England journal of medicine, 2018-06-14

Atezolizumab for First-Line Treatment of Metastatic Nonsquamous NSCLC.

The Lancet. Respiratory medicine, 2019-05

Atezolizumab plus bevacizumab and chemotherapy in non-small-cell lung cancer (IMpower150): key subgroup analyses of patients with EGFR mutations or baseline liver metastases in a randomised, open-label phase 3 trial.

Ann. Oncol.,

Severe immune-related adverse events are common with sequential PD-(L)1 blockade and osimertinib.

The New England journal of medicine, 2018-12-13

Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC.

The New England journal of medicine, 2017-08-31

Alectinib versus Crizotinib in Untreated ALK-Positive Non-Small-Cell Lung Cancer.

Ann Oncol, 2020 May 11

Updated overall survival and final progression-free survival data for patients with treatment-naive advanced ALK-positive non-small-cell lung cancer in the ALEX study.

N Engl J Med,

First-Line Lorlatinib or Crizotinib in Advanced -Positive Lung Cancer.

J Clin Oncol, 2020 Aug 11

Brigatinib Versus Crizotinib in Advanced ALK Inhibitor-Naive ALK-Positive Non-Small Cell Lung Cancer: Second Interim Analysis of the Phase III ALTA-1L Trial.

J Thorac Oncol,

Lorlatinib Should Not be Considered as the Preferred First-Line Option in Patients With Advanced ALK Rearranged NSCLC.

Cancer discovery, 2016-10

Molecular Mechanisms of Resistance to First- and Second-Generation ALK Inhibitors in ALK-Rearranged Lung Cancer.

The Lancet. Oncology, 2014-09

Safety and activity of alectinib against systemic disease and brain metastases in patients with crizotinib-resistant ALK-rearranged non-small-cell lung cancer (AF-002JG): results from the dose-finding portion of a phase 1/2 study.

Cancer Sci,

Pharmacologic study (JP28927) of alectinib in Japanese patients with ALK+ non-small-cell lung cancer with or without prior crizotinib therapy.

The New England journal of medicine, 2018-11-22

Brigatinib versus Crizotinib in ALK-Positive Non-Small-Cell Lung Cancer.

Journal of clinical pharmacology, 2018-12

Effect of Hepatic Impairment on the Pharmacokinetics of Alectinib.

Investigational new drugs, 2023 Apr 13

Brigatinib pharmacokinetics in patients with chronic hepatic impairment.

Case reports in oncology, 2021 Mar 01

Successful Treatment with Lorlatinib after the Development of Alectinib-Induced Liver Damage in ALK-Positive Non-Small-Cell Lung Cancer: A Case Report.

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2019-01

Increased Hepatotoxicity Associated with Sequential Immune Checkpoint Inhibitor and Crizotinib Therapy in Patients with Non-Small Cell Lung Cancer.

The American journal of surgical pathology, 2020 Sep

Colorectal Adenocarcinomas Harboring ALK Fusion Genes: A Clinicopathologic and Molecular Genetic Study of 12 Cases and Review of the Literature.

The oncologist, 2024 Feb 21

Anaplastic Lymphoma Kinase (ALK) Inhibitors Show Activity in Colorectal Cancer With ALK Rearrangements: Case Series and Literature Review.

Molecular cancer research : MCR, 2009 Sep 08

Exon array profiling detects EML4-ALK fusion in breast, colorectal, and non-small cell lung cancers.

N Engl J Med, 2020 Sep 19

Osimertinib in Resected -Mutated Non-Small-Cell Lung Cancer.

The New England journal of medicine, 2024 Apr 11

Alectinib in Resected -Positive Non-Small-Cell Lung Cancer.

The New England journal of medicine, 2024 Jun 02

Osimertinib after Chemoradiotherapy in Stage III -Mutated NSCLC.

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