Clinical case of prolonged use of alectinib in the treatment of ALK-positive NSCLC
https://doi.org/10.21518/2079-701X-2019-19-120-124
Abstract
Anaplastic lymphoma kinase (ALK) translocation is a rare genetic disorder that underlies lung cancer development. As a rule, these are young people, people with no or little smoking experience in whom the diagnosis is made at a late stage of the disease, when there are distant metastases; the liver and brain are often affected.
The right choice of treatment policy in patients with ALK-positive non-small cell lung cancer can significantly improve survival rates. And molecularly targeted therapy with ALK inhibitors is effective even in these cases.
Crizotinib (Xalkori). is the first ALK inhibitor that has been proven its antitumor activity. However, despite the initial pronounced antitumor effect, most patients develop drug resistance after 1–2 years of administration to krizotinib. In this case, the prescription of the second-generation drugs alectinib (Alecensa) and ceritinib (Zykadia) allows half of the patients to achieve a long objective response. Nevertheless today, alectinib in first-line demonstrates the best long-term results: the median progression-free survival is more than 34 months, 4-year overall survival rate is 64.5%. The drug has been shown a high activity in patients with brain metastases. Alektinib therapy not only has an advantage in terms of survival over Crizotinib, but also has an acceptable safety profile. This opens up new perspectives in the treatment of ALK-positive patients.
The right choice of treatment policy in patients with ALK-positive non-small cell lung cancer can significantly improve survival rates. And molecularly targeted therapy with ALK inhibitors is effective even in these cases.
Crizotinib (Xalkori). is the first ALK inhibitor that has been proven its antitumor activity. However, despite the initial pronounced antitumor effect, most patients develop drug resistance after 1–2 years of administration to krizotinib. In this case, the prescription of the second-generation drugs alectinib (Alecensa) and ceritinib (Zykadia) allows half of the patients to achieve a long objective response. Nevertheless today, alectinib in first-line demonstrates the best long-term results: the median progression-free survival is more than 34 months, 4-year overall survival rate is 64.5%. The drug has been shown a high activity in patients with brain metastases. Alektinib therapy not only has an advantage in terms of survival over Crizotinib, but also has an acceptable safety profile. This opens up new perspectives in the treatment of ALK-positive patients.
About the Authors
S. G. Bagrova
Federal State Budgetary Institution «Blokhin National Medical Research Cancer Centre» of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Cand. of Sci. (Med.), Researcher, Oncology Drug Therapy (Chemotherapy) Department No. 1
23, Kashirskoe shosse, Moscow, 115478, Russia
A. A. Kolomeytseva
P. A. Hertsen Moscow Oncology Research Institute – Branch of Federal State Budgetary Institution «Blokhin Russian Cancer Research Center» of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Cand. of Sci. (Med.), Head of Day Patient Hospital, Outpatient Department
Bldg. 1, 6, Pogodinskaya St., Moscow, 119121, Russia
E. V. Trusilova
Federal State Budgetary Institution «Blokhin National Medical Research Cancer Centre» of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Cand. of Sci. (Med.), Researcher, Oncology Drug Therapy (Chemotherapy) Department No. 1
23, Kashirskoe shosse, Moscow, 115478, Russia
V. A. Gorbunova
Federal State Budgetary Institution «Blokhin National Medical Research Cancer Centre» of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Dr. of Sci. (Med.), Professor, Principal Researcher, Oncology Drug Therapy (Chemotherapy) Department No. 1
23, Kashirskoe shosse, Moscow, 115478, Russia
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Review
For citations:
Bagrova SG, Kolomeytseva AA, Trusilova EV, Gorbunova VA. Clinical case of prolonged use of alectinib in the treatment of ALK-positive NSCLC. Meditsinskiy sovet = Medical Council. 2019;(19):120-124. (In Russ.) https://doi.org/10.21518/2079-701X-2019-19-120-124
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