Opinion
Video
Updates in ALK+ NSCLC: ALINA Trial at ESMO 2023
Patrick Forde, MBBCh, discusses ALK rearrangement in NSCLC and highlights ALINA trial results from ESMO 2023.
This is a video synopsis/summary of a Post Conference Perspectives involving Patrick Forde, MBBCh.
Forde discusses recent results from the ALINA trial of alectinib in early-stage ALK-positive (ALK+) non–small cell lung cancer (NSCLC). ALK alterations (fusion genes) occur in about 2% of NSCLC tumors, predominantly in younger nonsmokers. Alectinib is approved in advanced NSCLC with an ALK alteration based on improved efficacy and tolerability over crizotinib. The ALINA trial randomly assigned patients with resected stage IB to IIIA (equivalent to current stage II-IIIA) ALK+ NSCLC to either adjuvant platinum doublet chemotherapy or up to 2 years of alectinib. Alectinib significantly reduced the risks of disease recurrence or death by 76% compared with platinum doublet chemotherapy. Alectinib also markedly decreased brain metastases, which commonly occur with ALK+ NSCLC. Preliminary 3-year follow-up data suggests a benefit persisting after stopping alectinib at 2 years.
Forde states these results are a significant advance and alectinib will likely become the standard of care once approved in this setting. He notes some open questions remain regarding whether to give chemotherapy first followed by alectinib or proceed directly to alectinib, given the 5% benefit of surgery followed by adjuvant chemotherapy historically. However, either approach will provide significant benefits for patients with resected ALK+ NSCLC compared with previous options.
Video synopsis is AI-generated and reviewed by AJMC® editorial staff.
