Dr. Kerrigan on Sequencing Challenges in ALK+ NSCLC

Katie Kerrigan, MD, a hematology/oncology fellow at Huntsman Cancer Institute, University of Utah School of Medicine, discusses sequencing challenges in the treatment of patients with ALK-positive non—small cell lung cancer.

One of the biggest challenges that needs to be addressed with future research has to do with determining the optimal sequencing of available agents, says Kerrigan. Patients with ALK-mutated disease often live a long time, and there are no overall survival data available for the available second- and third-generation ALK TKIs, Kerrigan adds.

Understanding how best to sequence these agents is necessary to provide patients with the maximum benefit for the longest period of time. In the United States, alectinib (Alecensa) has become the frontline standard of care for patients with ALK-positive disease, based on findings from the phase III ALEX trial. It is unknown whether another second-generation TKI, brigatinib (Alunbrig), is efficacious post-alectinib, says Kerrigan. In fact, data from some retrospective reviews suggest that the agent may not be too active in these patients, and that lorlatinib (Lorbrena) may be the superior option.

Another unanswered question has to do with the role of immunotherapy in this space, adds Kerrigan. Although available data suggest that single-agent immunotherapy may not be effective in this patient population, researchers postulate that more activity may be observed if the approach is combined with chemotherapy or chemotherapy plus a VEGF inhibitor, concludes Kerrigan.