What are ASCO/OH(CCO) recommendations for treating stage IV non–small cell lung cancer (NSCLC) in patients with ALK alterations?

Updated: Jul 15, 2021
  • Author: Winston W Tan, MD, FACP; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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Answer

First-line therapy:

  •  Alectinib or brigatinib should be offered.
  • If alectinib and brigatinib are not available, ceritinib or crizotinib should be offered.

Second-line therapy

  • If alectinib or brigatinib was given in the first-line setting, lorlatinib may be offered.
  • If crizotinib was given in the first-line setting, then alectinib, brigatinib, or ceritinib should be offered.

Third-line therapy

  • If crizotinib was given in the first-line setting and alectinib, brigatinib, or ceritinib in the second-line setting, then lorlatinib may be offered, or standard treatment for NSCLC without driver mutations may be offered.

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