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. .

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. 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.

Dr. Nathan Pennell, Cleveland Clinic, describes other options for treatment of acquired resistance, including chemotherapy, ablation with SBRT and a combination of Gilotrif and Erbitux.

Dr. Nathan Pennell, Cleveland Clinic, reviews the available trial evidence for the use of targeted therapies in the post-operative/adjuvant setting.

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.

Dr. Jack West asks the question of whether newer, more active ALK inhibitors such as alectinib should be used as first line therapy rather than for acquired resistance, including introducing the ALEX trial that is trying to answer this question.

ROS1 lung cancer patient Lisa Goldman credits research with keeping her alive. November is Lung Cancer Awareness Month. What are you grateful for?

Dr. Thomas John of the Olivia Newton-John Cancer Center in Melbourne, Australia presents his favorite breakthroughs in lung cancer from 2014.

For those who wish to access the PDF, it's here: Thomas John, MD Top Four Lung Cancer Highlights 2014

Agree? Disagree? What are you looking forward to in 2015?

An annual tradition is a reflection on the key developments in the field over the past year. This year saw some major advances, with several of the biggest changes bubbling just below the surface and about to really break out in 2015.  So without further adieu, here's my list.

For those who wish to access the pdf, it's here: Top 5 Highlights in Lung Cancer 2014

Agree? Disagree? What's highest on your wish list for 2015?