Canadian consensus: inhibition of ALK-positive tumours in advanced non-small-cell lung cancer

B. Melosky, J. Agulnik, R. Albadine, S. Banerji, D.G. Bebb, D. Bethune, N. Blais, C. Butts, P. Cheema, P. Cheung, V. Cohen, J. Deschenes, D.N. Ionescu, R. Juergens, S. Kamel-Reid, S.A. Laurie, G. Liu, W. Morzycki, M.S. Tsao, Z. Xu, V. Hirsh


Anaplastic lymphoma kinase (ALK) is an oncogenic driver in non-small-cell lung cancer (NSCLC). Chromosomal rearrangements involving the ALK gene occur in up to 4% of nonsquamous NSCLC patients and lead to constitutive activation of the ALK signalling pathway. ALK-positive NSCLC is found in relatively young patients, with a median age of 50 years. Patients frequently have brain metastasis.

Targeted inhibition of the ALK pathway prolongs progression-free survival in patients with ALK-positive advanced NSCLC. The results of several recent clinical trials confirm the efficacy and safety benefit of crizotinib and ceritinib in this population.

Canadian oncologists support the following consensus statement: All patients with advanced nonsquamous nsclc (excluding pure neuroendocrine carcinoma) should be tested for the presence of an ALK rearrangement. If an ALK rearrangement is present, treatment with a targeted ALK inhibitor in the first-line setting is recommended. As patients become resistant to first-generation ALK inhibitors, other treatments, including second-generation ALK inhibitors can be considered.


ALK; anaplastic lymphoma kinase; non-small-cell lung cancer; molecular testing; targeted inhibition

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