[Therapeutic strategies in advanced ALK positive non-small cell lung cancer].
Fiche publication
Date publication
novembre 2019
Journal
Revue des maladies respiratoires
Auteurs
Membres identifiés du Cancéropôle Est :
Pr MASCAUX Céline
Tous les auteurs :
Tiotiu A, Billon Y, Vaillant P, Menard O, Hofman P, Mascaux C
Lien Pubmed
Résumé
Anaplastic lymphoma kinase (ALK) rearrangement is a therapeutically targetable oncogenic driver found in 5% of patients with non-small-cell lung cancer (NSCLC). The objective of this paper is to synthesise current knowledge on ALK rearrangement and its impact on the management of advanced NSCLC. Several inhibitors of the tyrosine kinase of ALK (crizotinib, ceritinib, alectinib) have been approved as first line therapies in patients with advanced ALK positive NSCLC, which are associated with a better median progression-free survival than conventional chemotherapy. Unfortunately, the emergence of drug resistance leads to tumor progression. In patients with oligoprogressive disease if local ablative therapy can be effected, continuing with the same ALK tyrosine kinase inhibitor is one option. In patients with progression, clinicians may consider switching to another therapy. Rebiopsy of the tumor or liquid biopsy could be attempted to identify the mechanisms of resistance and to customize ALK-target therapy. The emergence of crizotinib drug resistance has prompted the development of next generation drugs including ceritinb, alectinib, brigatinib and lorlatinib. The ability to quickly develop targeted therapies against specific oncogenic drivers will require close co-operation between pathologists, pulmonologists and oncologists in the future to keep pace with drug discoveries and to define optimal therapeutic strategies.
Mots clés
ALK TKI, ITK ALK, Rebiopsie, Rebiopsy, Resistance, Résistance, Stratégie thérapeutique, Therapeutic strategy
Référence
Rev Mal Respir. 2019 Nov 11;: