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    How I treat ALK-positive non-small cell lung cancer

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    Author
    McCusker, M.G.
    Russo, A.
    Scilla, K.A.
    Mehra, R.
    Rolfo, C.
    Date
    2019
    Journal
    ESMO Open
    Publisher
    BMJ Publishing Group
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://www.doi.org/10.1136/esmoopen-2019-000524
    Abstract
    Since the discovery of anaplastic lymphocyte kinase (ALK) rearrangement in non-small cell lung cancer (NSCLC) and subsequent development of increasingly effective and central nervous system (CNS)-penetrant first-generation, second-generation and third-generation ALK tyrosine kinase inhibitors (TKIs), the landscape of resistance mechanisms and treatment decisions has become increasingly complex. Tissue and/or plasma-based molecular tests can identify not only the rearrangement proper but also common resistance mechanisms to guide decision-making for further lines of treatment. However, frequently encountered questions exist regarding how to diagnosis ALK rearrangement, how to select a first-line ALK TKI, how to diagnose and manage ALK TKI resistance, how to control CNS disease and how to handle failure of ALK inhibition. Herein, we attempt to answer these questions through the evidence-based interpretation of studies on ALK-rearranged NSCLC combined with experience gained from our institution. The authors also propose a therapeutic algorithm for the management of this complex and highly treatable disease to assist clinicians globally in the treatment of patients with ALK-positive NSCLC. Copyright Author (s) or their employer(s) 2019.
    Keyword
    Acquired resistance
    Alectinib
    ALK
    Ceritinib
    Crizotinib
    Lorlatinib
    NSCLC
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85069777523&doi=10.1136%2fesmoopen-2019-000524&partnerID=40&md5=a9b29eeda85cd33dd8ef28b94352d179; http://hdl.handle.net/10713/10337
    ae974a485f413a2113503eed53cd6c53
    10.1136/esmoopen-2019-000524
    Scopus Count
    Collections
    UMB Open Access Articles 2019

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