The FDA just approved a new therapy for the approximately 4% of patients with NSCLC who have the molecular marker known as an ALK rearrangement. The agent Zykadia (ceritinib), a "second generation" ALK inhibitor that is more effective than Xalkori (crizotinib) in lab models of ALK-positive NSCLC, and the new approval was for Zykadia as first line treatment for ALK-positive lung cancer, a setting where we have historically favored Xalkori since it was approved in 2011. .

GRACE is happy to present the 5th in our series ASCO 2016 Lung Cancer Roundtable, Highlights and New Approaches in Lung Cancer.  Featuring Jack West, MD, Janet Freeman-Daily, Everett Vokes, MD, and Suresh Ramalingam, MD, this roundtable discussion, moderated by Dr. West, highlights the newest and most intriguing discussions from ASCO 2016.

Drs. West, Vokes and Ramalingam, along with patient advocate Janet Freeman-Daily, discuss the J-ALEX trial and whether Alecensa should replace Xalkori as a first-line ALK therapy.

Probably the most immediate potentially practice-changing presentation from ASCO was the Japanese J-ALEX study in the subset of about 4-5% of patients with non-small cell lung cancer (NSCLC) who have the molecular driver known as an anaplastic lymphoma kinase (ALK) rearrangement, which we now routinely test for from the tumor tissue of patients with a non-squamous metastatic NSCLC.

Dr. Ross Camidge, University of Colorado, addresses the question of whether to use a second generation ALK inhibitor as first line therapy or only after acquired resistance to crizotinib.

Dr. Ross Camidge, University of Colorado, describes the second generation ALK-inhibitors which provide good options for ALK-positive NSCLC patients who have developed acquired resistance to crizotinib.

Dr. Jared Weiss, UNC Lineberger Comprehensive Cancer Center, describes the types of situations in which local therapy is appropriate for treating limited acquired resistance.

Dr. Nathan Pennell, Cleveland Clinic, discusses acquired resistance to Xalkori in ALK-positive patients, and second generation inhibitors designed to overcome that resistance, such as Zykadia and alectinib.

Xalkori (critzotinib) was the first approved treatment for ALK+ and ROS1 lung cancer. Since then, other drugs have been approved or are currently undergoing scientific review. In this video, Dr. Owonikoko outlines these options for patients.

Drs. Leora Horn, Ben Solomon, & Jack West review whether there are specific factors that should make one second generation ALK inhibitor more ideal than other competing options for a specific patient with an ALK rearrangement.

Drs. Ben Solomon, Leora Horn, & Jack West evaluate the evidence and consider whether there are clinically significant differences among the second generation ALK inhibitors that would lead to a reason to prefer one over another for a particular patient.