Lung Cancer

Although crizotinib is the standard of care for the first-line treatment of patients with ALK-positive non–small-cell lung cancer, disease progression occurs in most crizotinib-treated patients, often calling for the use of second-generation ALK inhibitors such as alectinib, brigatinib, and ceritinib, among other treatment strategies.
Results from a phase 2 trial of lorlatinib, an investigational, next-generation tyrosine kinase inhibitor, showed efficacy in treating lung tumors and brain metastases in patients with ALK-positive and ROS1-positive advanced non–small-cell lung cancer, including those who have been heavily pretreated.
Updated data from the phase 2 ALTA trial continue to support the efficacy and tolerability of brigatinib, an oral inhibitor of anaplastic lymphoma kinase (ALK), in patients with locally advanced or metastatic ALK-positive non–small-cell lung cancer (NSCLC) who have progressed while using crizotinib.
Until the expanded approval of afatinib, no targeted treatment options were available for patients with non–small-cell lung cancer (NSCLC) who harbored rare, nonresistant EGFR mutations, such as S768I, L861Q, and G719X. Among oral tyrosine kinase inhibitors approved for use in EGFR mutation–positive NSCLC, afatinib now offers the broadest first-line indication.
In patients with stage III non–small-cell lung cancer (NSCLC) whose disease did not progress after 2 or more cycles of platinum-based chemoradiotherapy, use of durvalumab as consolidation therapy significantly improved progression-free survival.
According to the results of a recent phase 2 clinical trial, treatment with a regimen of dabrafenib, an oral BRAF inhibitor, plus trametinib, an MEK inhibitor, is effective and tolerable in previously untreated patients with BRAF V600E‒mutated metastatic non–small-cell lung cancer (NSCLC).
Rovalpituzumab tesirine, an investigational antibody-drug conjugate that targets delta-like protein 3, shows encouraging single-agent efficacy with a manageable safety profile in the treatment of patients with recurrent small-cell lung cancer, according to recently published results.

Chicago, IL—Alectinib (Alecensa), a next-generation anaplastic lymphoma kinase (ALK) inhibitor, was called a new standard of care for patients with ALK mutation–positive non–small-cell lung cancer (NSCLC), based on results of the phase 3 ALEX clinical trial, which were presented at the 2017 ASCO annual meeting.

Chicago, IL—Osimertinib (Tagrisso) extends progression-free survival (PFS) compared with standard chemotherapy in patients with EGFR T790M mutation–positive non–small-cell lung cancer (NSCLC) who have central nervous system (CNS) metastases, reported Marina C. Garassino, MD, Thoracic Oncology Unit, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, at the 2017 ASCO annual meeting.
Dacomitinib is an irreversible EGFR tyrosine kinase inhibitor that inhibits 3 members of the ErbB protein family—EGFR/HER1, HER2, and HER4—implying that dacomitinib induces a more potent inhibition of EGFR.
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