•
Sequential TKI therapy with 2 or more ALK TKIs is standard for
ALK
+ NSCLC
•
Alectinib and other next generation ALK TKIs will likely move into the front-line setting
•
Numerous combination strategies for
ALK
+ NSCLC are being evaluated in clinical trials
•
CNS metastases are a challenge in
ALK
+ NSCLC!
•
MRI controls are recommended every 3-6 months; even in asymptomatic patients
•
WBRT is associated with substantial long-term toxicity
•
Sequential second- and third-generation ALK inhibitors yield median OS >40 months, with high
CNS efficacy
•
In isolated CNS progression, switch of ALK inhibitor should be considered
•
Resistance testing will be more important once more ALK inhibitors are available
Summary
