Patient case: 64-year-old female with Lung adenocarcinoma. Genetic variant: ALK Fusion. Other conditions: Emphysema.

Clinical trial: Trial of Brigatinib After Treatment With Second-Generation ALK Inhibitors

Summary: The purpose of this study is to evaluate the safety and effectiveness of this investigational drug, brigatinib (AP261136) in patients with advanced non-small cell lung cancer Non-small cell lung cancer (NSCLC) who have had first-line treatment for their cancer and it still got worse, even after, or while taking drugs called ALK inhibitors, or anti-cancer drugs that act on tumors. Some examples of these anti-cancer drugs are: KEYTRUDA® or ALECENSA®).

Detailed description: A significant population of Anaplastic Lymphoma Kinase (ALK) plus Non-small cell lung cancer patients exist that have progressed on or who were intolerant of second generation anaplastic lymphoma kinase inhibitor (e.g. ceritinib or alectinib). Brigatinib has demonstrated activity in patients who have progressed on crizotinib, but the activity of brigatinib in patients who have progressed on ceritinib, alectinib, or other second generation anaplastic lymphoma kinase inhibitors is unknown. Based on the preclinical data. 3, brigatinib is the only known anaplastic lymphoma kinase inhibitor with potent activity against known secondary anaplastic lymphoma kinase mutations suggesting it may retain activity as third-line treatment of anaplastic lymphoma kinase plus disease.
  Patients enrolled in ARI-AT-002 must have previously received a second generation Anaplastic lymphoma kinase inhibitor other than brigatinib. Given that third-line treatment of anaplastic lymphoma kinase plus disease is analogous to a phase I population, we have chosen 20% as a clinically meaningful response rate that would justify further study of brigatinib in previously treated anaplastic lymphoma kinase plus disease.

Eligibility: Inclusion Criteria:
  -  Locally advanced or metastatic non small cell lung cancer that has been cytologically or histologically confirmed
  -  Anaplastic lymphoma kinase rearrangement based on FDA approved test (e.g., Vysius break apart fluorescence in situ hybridization (FISH) or Immunohistochemistry (IHC) using Ventana)
  -  Eastern Cooperative Oncology Group (ECOG) performance status greater than or equal to 2
  -  Age 18 years or older
  -  Previous treatment with one second generation ALK inhibitor (e.g., ceritinib or alectinib) other than brigatinib
  -  Brain lesions may be used as target lesions if progressing, are greater than or equal to 10mm in longest diameter and if they were not previously treated with any of the following: whole brain radiation therapy within 3 months; Stereotactic radiosurgery; surgical resection
  -  Availability of core biopsy of progressive lesion taken within 60 days prior to D1 of treatment under study therapy or willing to undergo tumor biopsy: NOTE:. All subjects must consent to provide tumor blocks or slides. If archival tissue is not available and biopsies to obtain fresh tumor tissue cannot be performed with minimal risk to the subject, subjects may be permitted to enroll on the study with prior approval of the Study PI.
  -  Recovered from toxicities related to prior anticancer treatment to greater than or equal to grade 2 or baseline with the exception of alopecia
  -  Have normal QT interval on ECG evaluation QT corrected Fridericia (QTcF) of ≤ 450 ms in males or ≤ 470 ms in females
  -  Adequate organ function
  -  At least 1 measurable lesion per RECIST version 1.1
  -  Negative serum pregnancy test within 7 days of day 1 of treatment in women of childbearing potential
  -  If fertile, willing to use highly effective form of contraception during the dosing period and for at least 4 months after the dosing period
  -  Ability to provide signed informed consent and willing and able to comply with all study requirements
  Exclusion Criteria:
  -  History or the presence of pulmonary interstitial disease, drug-related pneumonitis, or radiation pneumonitis
  -  Prior treatment with brigatinib
  -  History of or active significant gastrointestinal bleeding within 3 months
  -  Malabsorption syndrome or other gastrointestinal illness that could affect oral absorption of the study drug
  -  Received cytotoxic chemotherapy, investigational agents or radiation within 7 days prior to day 1 of study treatment
  -  Received prior ALK TKI therapy within 7 days prior to day 1 of treatment under study drug. 7 day wash out period is required after prior ALK inhibitor treatment
  -  Have significant, uncontrolled, or active cardiovascular disease
  -  Have been diagnosed with another primary malignancy within the past 3 years (except for adequately treated non-melanoma skin cancer, cervical cancer in situ, or prostate cancer, which are allowed within 3 years)
  -  Have symptomatic central nervous system (CNS) metastases that are neurologically unstable or require an increasing dose of corticosteroids
  -  Have active infection requiring intravenous antibiotics
  -  Pregnant or breastfeeding
  -  Have any condition or illness that, in the opinion of the investigator would compromise patient safety or interfere with evaluation of the study drug

Relevance to patient case: possibly relevant