Treatment of Stage IV Lung Cancer With ALK Rearrangement
Identification of an ALK gene rearrangement in a lung cancer is important for deciding the optimal treatment course. The ALK rearrangement means that drugs that specifically act against the abnormal fusion protein can be used. Three drugs, crizotinib (Xalkori), ceritinib (Zykadia), and alectinib (Alecensa), have been developed to target the activity of the abnormal fusion protein, and additional agents are under development. For patients with advanced or metastatic ALK-positive NSCLC who do not have metastases to the brain, the ALK inhibitor crizotinib is the recommended therapy. Ceritinib or alectinib is typically given if the cancer becomes resistant to crizotinib or if the patient is unable to tolerate crizotinib.