Options for Patients With Lung Cancer and Genetic Alterations

Luis E. Raez, MD, medical director of Memorial Cancer Institute, and chief of Hematology/Oncology at Memorial Healthcare System, discusses targeted therapies for patients with lung cancer who have genetic alterations.

Raez covers the 5 drugs that are available for patients withALKmutations. He says that according to the guidelines for lung cancer, alectinib (Alecensa) is most likely the preferred first-line agent because it goes to the brain and protects the patient, compared to when crizotinib (Xalkori) was used and patients would fail in the brain and develop brain metastases. After alectinib, brigatinib (Alunbrig) and lorlatinib (Lorbrena) can be given to these patients.

A problem that has risen in this setting is mutations can become resistant to therapy in the same way that they would become resistant to antibiotics, according to Raez. Patients that receive any of these FDA-approved therapies can develop resistance to mutations. Raez and his colleagues are asking whether patients should be tested for resistant mutations, since that is what happens with antibiotics. If a patient fails with an antibiotic, they are tested for resistant mutations with a culture. Whether physicians use the 5 agents imperially or do resistant mutation testing for the patient after they fail 1 agent to see how they should be treated next remains in question.

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