ALK-positive NSCLC: the role of treatment selection and sequencing

Benjamin Besse, MD, PhD, of the Gustave Roussy Institute, Villejuif, France, suggests that great care should be taken when considering treatment selection and sequencing of tyrosine kinase inhibitors (TKIs) for patients with ALK-positive non-small cell lung cancer (NSCLC). Though first generation drugs like crizotinib may result in lower rates of PFS than second and third generation treatments, gradual change in treatment regimens and dosage may in fact result in longer overall survival. Dr Besse also discusses implications of resistance in research versus clinical practice, as well as the varying toxicity profiles between each of the three treatment generations, and calls for a better understanding of resistance through liquid biopsy.