Dr. Joshua Sabari, a professor at New York University’s Department of Medicine, has recently spoken about the different treatment options for ALK-positive non-small cell lung cancer (NSCLC). Specifically, he discussed the different ALK inhibitor options, of which the there are several.
Dr. Sabari discusses how choosing a treatment for NSCLC patients can be so difficult because of how many ALK inhibitors have been FDA approved for the condition. Some of these include crizotinib, brigatinib, lorlatinib, and alectinib.
He further explains that personally, he prefers to prescribe alectinib for his patients. Dr. Sabari uses the 600mg dose twice each day. He prefers this inhibitor for many reasons. First and foremost, the treatment produced great efficacy results in two phase 3 investigations (ALEX and J-ALEX). You can read more about these clinical trials by searching NCT02075840 and JapicCTI-132316.
Additionally, alectinib has been found to be very well tolerated by many patients. The treatment leads to positive central nervous system activity as well as eliciting good activity against some of the resistance mechanisms present from the early ALK inhibitors.
Alectinib has been found to lead to significantly better progression-free survival when compared to crizotinib. While Phase 3 trial called CROWN (NCT03052608) demonstrated that lorlatinib was actually more efficacious than crizotinib, the treatment was found to be linked to neurologic toxicities. Some of these include dizziness, ataxia, and other neurocognitive complications.
Therefore, Dr. Sabari prefers using lorlatinib as a second-line therapy for his patients.
You can read more about these different ALK inhibitors for NSCLC patients, as well as Dr. Sabari’s opinion on them here.