Lung cancer
ICD-10 C34 · ICD-11 2C25.Z

Treatment of Advanced or Metastatic Non-Small Cell Lung Cancer with ALK Gene Fusion After Progression on an ALK Inhibitor

This protocol covers patients with advanced or metastatic non-small cell lung cancer (NSCLC) in whom an ALK gene fusion has been confirmed and who have experienced disease progression on a prior ALK-targeted therapy.

Clinical Scenario

Advanced or metastatic NSCLC with a confirmed ALK gene fusion. ALK fusions occur in approximately 5% of patients with NSCLC and are associated with sensitivity to oral ALK tyrosine kinase inhibitors (TKIs). This protocol applies when disease has progressed despite treatment with an ALK TKI.

Treatment Approach — Partial Overview

Subsequent management involves switching to an alternative ALK-targeted agent, with the specific choice informed by which prior ALK inhibitor was received.

The complete sequencing algorithm, including agent selection by prior therapy, is in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

  1. An ALK gene fusion is present in about 5% of patients with NSCLC.
  2. The presence of an ALK gene fusion is associated with responsiveness to oral ALK TKIs.
  3. After progression on alectinib, brigatinib, ceritinib, or ensartinib, the Panel recommends a switch in treatment to lorlatinib.
  4. Lorlatinib can be used for NSCLC with resistant mutations such as ALK G1202R or L1196M, but not if compound-resistant mutations are detected (ie, both L1196M and G1202R).
View source ↗