Current Access to Anaplastic Lymphoma Kinase Testing and Targeted Therapies for Non-Small Cell Lung Cancer in Brazil:...

In Brazil, diagnosing and treating non-small cell lung cancer (NSCLC) with actionable molecular alterations pose substantial challenges because of health care disparities. Anaplastic lymphoma kinase (ALK) rearrangements represent a clinically relevant subset with highly effective targeted therapies. However, real-world access to ALK diagnostics and treatments across different Brazilian health care sectors remains inadequately characterized.

We conducted a cross-sectional survey of Brazilian oncologists between October 2024 and March 2025 to assess the availability of ALK testing and targeted therapies, alongside perceived implementation barriers. Of 197 responses collected, 156 were included in the final analytic cohort. Data were analyzed using descriptive statistics, and categorical variables were reported as proportions with 95% CIs.

Within the final analytic cohort (N = 156), 93.9% of the respondents practicing in the private sector (n = 147) reported access to ALK testing, whereas only 43.9% of those practicing in the public health care system (n = 107) had access. Access to ALK-targeted therapies was limited for the public health care population: 7.1% received crizotinib and <2% received newer-generation ALK-targeted therapies available in the first-line setting. By contrast, in the private sector, 75.6% and 60.9% reported access to alectinib and lorlatinib, respectively. Chemotherapy remained predominant in the public health care system. Main barriers included lack of reimbursement (58.3%), insufficient tissue (40.4%), and urgency to initiate treatment (36.5%).

Despite robust evidence supporting ALK-targeted therapies, this study highlights substantial disparities in access to diagnostics and treatment for ALK-rearranged NSCLC in Brazil, particularly among patients reliant on the public health care system. Findings underscore the need for policies to strengthen testing infrastructure, ensure equitable access to guideline-recommended therapies, and enhance provider education. Addressing these gaps is essential for equitable precision oncology and improved outcomes.