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Alectinib vs Crizotinib in ALK-Positive NSCLC

By: Meg Barbor, MPH
Posted: Monday, June 26, 2017

Compared with crizotinib, alectinib resulted in improved progression-free survival in patients with anaplastic lymphoma kinase (ALK)-positive non–small cell lung cancer (NSCLC), according to the results of the open-label phase III J-ALEX trial, led by Toyoaki Hida, MD, of Aichi Cancer Center in Nagoya, Japan, and colleagues. The results were published recently in The Lancet.

This is the first head-to-head comparison of alectinib and crizotinib. The investigators believe their results have the potential to change the standard of care for the first-line treatment of ALK-positive NSCLC.

A total of 207 ALK inhibitor–naive patients with ALK-positive NSCLC who had received up to 1 previous chemotherapy regimen were randomized to receive oral alectinib at 300 mg (n=103) or crizotinib at 250 mg (n=104) twice daily until progressive disease, unacceptable toxicity, death, or withdrawal. (The investigators mentioned the dose of alectinib used in this trial is lower than the approved dose outside of Japan.)

After a median follow-up of about 12 months, median progression-free survival was not reached in the alectinib group and was 10.2 months in the crizotinib group. The benefit of alectinib was apparent in patients with postoperative recurrence, as well as in those with advanced disease.

Grade 3/4 adverse events occurred in 26% of the alectinib group, versus 52% of the crizotinib group. Dose interruptions due to adverse events were also more prevalent with crizotinib (74%) than with alectinib (29%).