Dr. Otterson on Targetable Biomarkers in Lung Cancer

Gregory A. Otterson, MD, professor of internal medicine, associate division director for Education, co-director of the Thoracic Oncology Program for the Division of Medical Oncology, and associate director for the Hematology and Medical Oncology Fellowship Program, The Ohio State University Comprehensive Cancer Center—The James, discusses targetable biomarkers in non–small cell lung cancer (NSCLC).

Four actionable biomarkers exist in lung cancer: ALK, ROS1, BRAF, and NTRK; all of them have FDA approved drugs that are very effective. The agents targeting ALK alterations are often discussed, as they have shown the most activity. The first 2 drugs that were approved were crizotinib (Xalkori) and ceritinib (Zykadia) for use in previously untreated patients with metastatic ALK-positive NSCLC; however, they are not used as often as they used to be, since the next generation of drugs have emerged in the treatment landscape.

Alectinib (Alecensa), brigatinib (Alunbrig), and lorlatinib (Lorbrena) received subsequent approval for use in this patient population, says Otterson, and these agents appear to have much greater activity and tolerability. When alectinib and brigatinib were compared with crizotinib in the first-line setting, they both showed much better progression-free survival as well as improved central nervous system penetration and control. Additionally, a study comparing lorlatinib with crizotinib has completed accrual. The real question that all investigators hope to answer is how the newer agents compare with one another; however to date, the answer is unknown, concludes Otterman.