Sharing Experience with Anaplastic Lymphoma Kinase Tyrosine Kinase Inhibitors in Lung Cancer: An Italian Expert Panel Discussion.

Autor: Gridelli C; Division of Medical Oncology, 'S.G. Moscati' Hospital, 83100 Avellino, Italy., Tiseo M; Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.; Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy., Cortinovis DL; SC Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy., Migliorino MR; Department of Oncology, San Camillo-Forlanini Hospital, 00152 Rome, Italy., Barbieri V; Medical Oncology Unit, AOU Renato Dulbecco, 88100 Catanzaro, Italy., Bironzo P; Department of Oncology, University of Turin, 10124 Turin, Italy., Bearz A; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy., Attili I; Division of Thoracic Oncology, European Institute of Oncology, IRCCS, 20141 Milan, Italy., de Marinis F; Division of Thoracic Oncology, European Institute of Oncology, IRCCS, 20141 Milan, Italy.
Jazyk: angličtina
Zdroj: Current oncology (Toronto, Ont.) [Curr Oncol] 2023 Nov 20; Vol. 30 (11), pp. 10033-10042. Date of Electronic Publication: 2023 Nov 20.
DOI: 10.3390/curroncol30110729
Abstrakt: Background: ALK tyrosine kinase inhibitors (TKIs) have revolutionized the treatment and largely improved the survival outcomes of patients with NSCLC harboring ALK rearrangements. Different ALK TKI compounds have demonstrated antitumor activity in these patients and are available in clinical practice. However, clinical expertise across countries varies according to local regulatory approval of different drugs, identifying multiple treatment scenarios to comply with international guidelines and clinical practice.
Methods: A virtual webinar was held on July 2023 to discuss the state of the art and future perspectives in the treatment of ALK rearrangement in advanced NSCLC in Italy. The faculty hosting the webinar was composed of eight medical oncologists from different regions of Italy with clinical expertise in treating patients with lung cancer. Live-shared notes were used to produce a report to serve as the basis of a review manuscript on the topic.
Results: Alectinib and brigatinib are the preferred front-line treatment options in Italy, pending approval of the front-line medicine lorlatinib, which would be considered among the choices. Due to a local regulatory limitation of second-line lorlatinib, which is not allowed after front-line brigatinib, alectinib is commonly the preferred front-line choice to follow a sequence of alectinib, followed by lorlatinib, followed by platinum plus pemetrexed chemotherapy. Age and performance status were not considered per se as clinical features influencing treatment choice. However, treatment compliance is deemed a relevant factor in decision making with regard to the number of pills to be administered. In general, given the availability of alternative choices, the spectrum of patients' comorbidities and polypharmacotherapy interactions should be taken into account in treatment selection according to the toxicity profile of each compound. In addition, several issues were debated with regard to improving treatment outcomes, including testing, brain metastases, and management of an oligoprogressive disease.
Conclusions: The treatment scenario of ALK-positive disease is dynamically evolving. Furthermore, not all FDA- and EMA-approved compounds are approved in Italy with the same indications. This influences therapeutic opportunities and increases the need for greater clinical expertise to help and guide treatment selection.
Databáze: MEDLINE
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