Dr. Alice T. Shaw on Ceritinib for Frontline ALK+ NSCLC With Brain Metastases

Alice T. Shaw, MD, PhD, thoracic oncologist at the Massachusetts General Hospital Cancer Center, discusses ceritinib in newly diagnosed patients with ALK-positive non-small cell lung cancer (NSCLC) and brain metastases.

A pooled analysis looked at patients from two different ceritinib studies—ASCEND 1, a phase I trial, and ASCEND 3, a phase II trial—that had not received a previous ALK-inhibitor and had brain metastases. The analysis found that the response rate in this group of patents was quite high, says Shaw. The systemic response rate was about 60% to 65%. What was particularly interesting, says Shaw, was that the intracranial response rate for patients with measurable brain metastases was also about 60%.

These findings suggest that ceritinib has significant potency and activity and can achieve a response rate in the brain that seems equal to what is achieved in the body. The median duration of response in the brain was also quite prolonged, says Shaw, at about 8 months.

This analysis provides further supports that ceritinib is very active in the frontline setting, including in patients with brain metastases, and that the next-generation ALK-inhibitors are also very effective in inducing durable responses in the brain.

Ceritinib is currently only approved for patients that have failed on crizotinib. However, ASCEND 1 and 3 really provided data on the activity of the ALK-inhibitor in the frontline setting. For a patient that presents with brain metastases newly diagnosed, crizotinib could be considered upfront because it penetrates the brain well, says Shaw.