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Published on: June 26, 2019
Alectinib for treatment of ALK-positive non-small-cell lung cancer
Virginie Avrillon1, Maurice Pérol1
1Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France.
Abstract:
Alectinib is a highly selective second-generation ALK inhibitor that is active against most crizotinib ALK resistance mutations, with a good penetration in CNS and a good safety profile. Thanks to the positive results of Phase II trials, alectinib was approved in Japan and by the US FDA for ALK-positive non-small-cell lung cancer (NSCLC) patients pretreated with crizotinib. Recently, the Phase III J-ALEX study demonstrated superiority of alectinib over crizotinib in crizotinib naive ALK-positive NSCLC, with an impressive improvement of progression-free survival. From the results and those expected of Phase III ALEX study, alectinib might become the frontline treatment of ALK-positive NSCLC. This article summarizes the therapeutic options in ALK-positive advanced NSCLC, and the chemical, pharmacodynamics, pharmacokinetics, metabolism and clinical efficacy of alectinib.
Insights
Alectinib shows superior progression-free survival compared to crizotinib in ALK-positive non-small-cell lung cancer (NSCLC). This positions alectinib as a potential frontline treatment for ALK-positive NSCLC patients.
Area of Science:
- Oncology
- Pharmacology
Background:
- Alectinib is a second-generation ALK inhibitor effective against crizotinib resistance mutations.
- It demonstrates good central nervous system penetration and a favorable safety profile.
Purpose of the Study:
- To review therapeutic options for ALK-positive advanced non-small-cell lung cancer (NSCLC).
- To summarize the chemical, pharmacodynamic, pharmacokinetic, metabolic, and clinical efficacy data of alectinib.
Main Methods:
- Review of Phase II and Phase III clinical trial data, including J-ALEX and expected ALEX study results.
- Analysis of preclinical and clinical data on alectinib's properties.
Main Results:
- Alectinib is approved for pretreated ALK-positive NSCLC patients in Japan and by the US FDA.
- The Phase III J-ALEX study demonstrated alectinib's superiority over crizotinib in progression-free survival for crizotinib-naive patients.
Conclusions:
- Alectinib exhibits significant efficacy and a good safety profile in ALK-positive NSCLC.
- Results suggest alectinib may become a preferred frontline therapy for ALK-positive NSCLC.
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