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

Clinical trial: ALTA-1L Study: A Phase 3 Study of Brigatinib Versus Crizotinib in ALK-positive Advanced Non-Small Cell Lung Cancer Patients

Summary: A Phase 3 Multicenter Open-label Study of Brigatinib (AP26113) versus Crizotinib in ALK-positive Advanced Lung Cancer Patients

Detailed description: The purpose of this phase III, randomized, open-label, comparative, multicenter, international study is to compare the efficacy and safety of brigatinib to that of crizotinib in anaplastic lymphoma kinase (ALK)-positive locally advanced or metastatic non-small cell lung cancer (NSCLC) patients who have not previously been treated with an ALK inhibitor. Participants will be randomized in a 1:1 ratio to receive either brigatinib, 90 milligrams (mg) orally once daily (QD) for 7 days, then a 180 mg orally QD, or crizotinib, 250 mg orally twice daily (BID). Participants will receive treatment until disease progression, intolerable toxicity, consent withdrawal, or death. The total estimated duration of the study is at least 5 years, including 2 years to accrue patients, with at least 3 years for treatment and follow-up.

Eligibility: Inclusion Criteria:
  1. Have histologically or cytologically confirmed stage IIIB (and not a candidate for definitive multimodality therapy) or stage IV NSCLC.
  2. Must have documented ALK rearrangement.
  3. Have sufficient tumor tissue available for central analysis.
  4. Have at least 1 measurable (i.e., target) lesion per RECIST v1.1.
  5. Recovered from toxicities related to prior anticancer therapy to NCI CTCAE v 4.0 grade ≤1.
  6. Are a male or female patient ≥18 years old.
  7. Have adequate organ function, as defined by the study protocol.
  8. Have Eastern Cooperative Oncology Group (ECOG) performance status ≤2.
  9. Have normal QT interval on screening ECG evaluation, defined as QT interval corrected (Fridericia) (QTcF) of ≤450 milliseconds (msec) in males or ≤470 msec in females.
  10. For female patients of childbearing potential, have a negative pregnancy test documented prior to randomization.
  11. For female and male patients who are fertile, agree to use a highly effective form of contraception, as defined by the study protocol.
  12. Provide signed and dated informed consent indicating that the patient has been informed of all pertinent aspects of the study, including the potential risks, and is willingly participating.
  13. Have the willingness and ability to comply with scheduled visit and study procedures.
  Exclusion Criteria:
  1. Previously received an investigational antineoplastic agent for NSCLC.
  2. Previously received any prior TKI, including ALK-targeted TKIs.
  3. Previously received more than 1 regimen of systemic anticancer therapy for locally advanced or metastatic disease.
  4. Received chemotherapy or radiation within 14 days of first dose of study drug, except stereotactic radiosurgery (SRS) or stereotactic body radiation therapy (SBRT).
  5. Received anti-neoplastic monoclonal antibodies within 30 days of the first dose of study drug.
  6. Had major surgery within 30 days of the first dose of study drug, minor surgical procedures such as catheter placement or minimally invasive biopsies are allowed.
  7. Have been diagnosed with another primary malignancy other than NSCLC, except for adequately treated non-melanoma skin cancer or cervical cancer in situ; definitively treated non-metastatic prostate cancer; or patients with another primary malignancy who are definitively relapse-free with at least 3 years elapsed since the diagnosis of the other primary malignancy.
  8. Have symptomatic CNS metastases (parenchymal or leptomeningeal) at screening or asymptomatic disease requiring an increasing dose of corticosteroids to control symptoms within 7 days prior to randomization.
  9. Have current spinal cord compression (symptomatic or asymptomatic and detected by radiographic imaging). Patients with leptomeningeal disease and without cord compression are allowed.
  10. Be pregnant, planning a pregnancy, or breastfeeding
  11. Have significant, uncontrolled, or active cardiovascular disease, as defined by the study protocol.
  12. Have uncontrolled hypertension.
  13. Have a history or the presence at baseline of pulmonary interstitial disease, drug-related pneumonitis, or radiation pneumonitis.
  14. Have an ongoing or active infection.
  15. Have a known history of human immunodeficiency virus (HIV) infection.
  16. Have a known or suspected hypersensitivity to brigatinib or its excipients and/or crizotinib or its excipients.
  17. Have malabsorption syndrome or other gastrointestinal (GI) illness or condition.
  18. Have any condition or illness that, in the opinion of the investigator, would compromise patient safety or interfere with the evaluation of the study drug.

Relevance to patient case: possibly relevant