Sie sind bereits registriert?
Loggen Sie sich mit Ihrem Universimed-Benutzerkonto ein:
Sie sind noch nicht registriert?
Registrieren Sie sich jetzt kostenlos auf universimed.com und erhalten Sie Zugang zu allen Artikeln, bewerten Sie Inhalte und speichern Sie interessante Beiträge in Ihrem persönlichen Bereich
zum späteren Lesen. Ihre Registrierung ist für alle Unversimed-Portale gültig. (inkl. allgemeineplus.at & med-Diplom.at)
Brigatinib for ALK-Positive, Non–Small-Cell Lung Cancer
Patients with anaplastic lymphoma kinase (ALK)–rearranged non–small-cell lung cancer (NSCLC) currently have the option of front-line therapy with the first-generation ALK tyrosine kinase inhibitor (TKI) crizotinib or next-generation ALK TKIs alectinib or ceritinib.
Now, investigators have conducted an industry-funded, international, randomized, open-label, phase III trial (ALTA-1L) to compare the efficacy of the next-generation ALK TKI brigatinib with that of crizotinib in 275 treatment-naive patients with advanced ALK-positive NSCLC.
The response rate was superior with brigatinib versus crizotinib, as were 12-month progression-free survival (the primary endpoint; 67% vs. 43%; hazard ratio, 0.49; P<0.001) and intracranial response (78% vs. 29%).
Comment
Brigatinib is now an additional ALK TKI option for patients with ALK-rearranged NSCLC. The agent has efficacy in the central nervous system and appears to have high systemic efficacy. The toxicity profile does include potential pulmonary toxicity that is of unclear etiology but that can be mitigated by including a 7-day lead-in 90-mg dose before escalating to a 180-mg daily dose. No direct front-line comparative trials between the next-generation ALK inhibitors are underway, and what the optimal sequence of these ALK agents should be is unknown. Preliminary studies have shown that ALK mutations may arise after treatment with certain ALK inhibitors but may be salvaged by other ALK inhibitors, and this complication may ultimately dictate the sequencing for individual patients. A National Cancer Institute–sponsored clinical trial with sequential biopsies and molecular profiling is underway to help determine the optimal sequencing of these agents.
Citation(s)
Author:
Camidge DR et al.
Title:
Brigatinib versus crizotinib in ALK-positive non–small-cell lung cancer.
Source:
N Engl J Med
2018
Sep
25; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Anne S. Tsao, MD