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

Topics: Thoracic Malignancies • Medical Oncology

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
Are there particular companies that are good at de...

Answer from: Medical Oncologist at Community Practice

This patient should have a biopsy to determine the mechanism of resistance. There are other agents approved including brigatinib or ceritinib. Lorlatinib is available on compassionate access and ensartinib is available in clinical trials for patients who have progressed on alectinib. A biopsy sho...

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Medical Oncologist at Center for Hematology and Oncology
thank you for the response. Is there a commercial...

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