How would you approach patients with ALK-positive metastatic NSCLC who progress on crizotinib and subsequently alectinib?

In the absence of clinical trial, is there are role for dose-escalating alectinib, or would you consider brigatinib or chemotherapy?

Answer from: Medical Oncologist at Academic Institution

Ideally, I would biopsy the recurrence to determine if there is a defined resistance mutation that might be targetable by brigatinib or lorlatinib. I always try to maintain TKIs as long as possible. Dose escalation might be effective, but would not be my first choice. If none ...

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Medical Oncologist at Center for Hematology and Oncology
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How would you approach patients with ALK-positive metastatic NSCLC who progress on crizotinib and subsequently alectinib?

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