| Molecular Profile |
Indication/Tumor Type |
Response Type |
Therapy Name |
Approval Status |
Evidence Type |
Efficacy Evidence |
References |
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Crizotinib
|
Guideline |
Actionable |
Xalkori (crizotinib) is included in guidelines as first-line and subsequent therapy for ALK rearranged non-small cell lung cancer (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Crizotinib
|
Phase III |
Actionable |
In a Phase III trial (PROFILE 1014), Xalkori (crizotinib) treatment resulted in improved progression-free survival (PFS) (PFS=10.9 months, n=172) relative to chemotherapy (PFS=7.0 months, n=171) in NSCLC patients with ALK rearrangements, including patients with and without brain metastases at baseline, and improved intracranial disease rate in patients with brain metastases at baseline (PMID: 27022118; NCT01154140).
|
27022118
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Crizotinib
|
FDA approved - On Companion Diagnostic |
Actionable |
In a Phase III trial (PROFILE 1014) that supported FDA approval, Xalkori (crizotinib) treatment resulted in improved progression-free survival (10.9 vs 7.0 months, HR=0.45, p<0.001) and objective response rate (74% vs 45%) relative to chemotherapy in NSCLC patients with ALK rearrangements (PMID: 25470694; NCT01154140).
|
detail...
25470694
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Crizotinib
|
Phase III |
Actionable |
In a Phase III trial, Xalkori (crizotinib) treatment resulted in improved objective response (87.5%, 90/103 vs 45.6%, 47/103) and median progression free survival (11.1 vs 6.8 mo) compared to pemetrexed, cisplatin and carboplatinin combination treatment in treatment-naive ALK positive advanced non-small cell lung carcinoma patients (J Clin Oncol 34, 2016 (suppl; abstr 9058); NCT01639001).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Crizotinib
|
Guideline |
Actionable |
Xalkori (crizotinib) is included in guidelines as first-line therapy for patients with metastatic non-small cell lung cancer harboring an ALK rearrangement, or as a next-line therapy in patients with ALK-rearranged non-small cell lung cancer who have not received prior (PMID: 31987360, PMID: 30285222; ESMO guidelines).
|
30285222
31987360
detail...
|
|
ALK rearrange
|
lung non-squamous non-small cell carcinoma
|
sensitive
|
Ceritinib
|
Phase III |
Actionable |
In a Phase III trial, first-line treatment with Zykadia (ceritinib) resulted in an improved median progression-free survival of 16.6 months, compared to 8.1 months with chemotherapy, in patients with ALK-rearranged non-squamous non-small cell lung cancer (PMID: 28126333; NCT01828099).
|
28126333
|
|
ALK rearrange
|
anaplastic large cell lymphoma
|
not applicable
|
N/A
|
Guideline |
Diagnostic |
ALK rearrangement aids in the diagnosis of anaplastic large cell lymphoma (NCCN.org).
|
detail...
|
|
ALK rearrange
|
anaplastic large cell lymphoma
|
not applicable
|
N/A
|
Guideline |
Prognostic |
The presence of ALK rearrangement is associated with a favorable prognosis in patients with anaplastic large cell lymphoma (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
no benefit
|
Crizotinib + Onalespib
|
Phase II |
Actionable |
In a Phase II trial, Onalespib (AT13387) and Xalkori (crizotinib) combination treatment did not significantly improve median progression free survival (269 vs 266 days) or objective response rate (55.4%, 38/68 vs 45.3%, 31/68) compared to Xalkori (crizotinib) single treatment in patients with non-small cell lung carcinoma harboring either an ALK mutation or ALK rearrangement (J Clin Oncol 34, 2016 (suppl; abstr 9059); NCT01712217).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
no benefit
|
Belizatinib
|
Phase I |
Actionable |
In a Phase I trial, treatment with Belizatinib (TSR-011) in ALK inhibitor-naive non-small cell lung cancer patients (n=14) harboring either an ALK mutation, ALK amplification, or an ALK rearrangement resulted in a partial response in 6 patients and stable disease in 8 patients, however, it was determined that the drug resulted in limited efficacy and development of the drug was discontinued (PMID: 31217479; NCT02048488).
|
31217479
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
no benefit
|
Nivolumab
|
Guideline |
Actionable |
Immune checkpoint inhibitors including Opdivo (nivolumab), Keytruda (pembrolizumab), Tecentriq (atezolizumab), and Imfinzi (durvalumab) are not indicated for use as subsequent therapy in non-small cell lung cancer patients with ALK rearrangement (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
no benefit
|
Nivolumab
|
Clinical Study - Cohort |
Actionable |
In a retrospective analysis, PD-1/PD-L1 inhibitors (Opdivo (nivolumab), Keytruda (pembrolizumab), Durvalumab (MEDI4736), or Tecentriq (atezolizumab)) resulted in lower objective response rate (3.6%, 1/28) in non-small cell lung cancer patients harboring EGFR mutations (22/28) or ALK rearrangement (6/28) compared to EGFR wild-type, ALK negative/unknown patients (23.3%, 7/30) (PMID: 27225694).
|
27225694
|
|
ALK rearrange
|
malignant pleural mesothelioma
|
no benefit
|
CT-707
|
Case Reports/Case Series |
Actionable |
In a Phase I trial, Conteltinib (CT-707) treatment resulted in disease progression after 1 cycle in a patient with ALK-rearranged malignant pleural mesothelioma (PMID: 32181989).
|
32181989
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Alectinib
|
FDA approved - On Companion Diagnostic |
Actionable |
In a Phase III trial supporting FDA approval (ALEX), Alecensa (alectinib) treatment resulted in improved rate of progression-free survival compared to Xalkori (crizotinib) (68.4% vs 48.7%, HR=0.47), and median progression-free survival (25.7 vs 10.4 months) in non-small cell lung cancer patients harboring ALK rearrangement (PMID: 28586279; NCT02075840).
|
28586279
detail...
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Alectinib
|
Guideline |
Actionable |
Alecensa (alectinib) is included in guidelines as the preferred first-line therapy and as subsequent therapy for patients with ALK-rearranged advanced or metastatic non-small cell lung cancer (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Alectinib
|
Clinical Study - Cohort |
Actionable |
In a retrospective analysis, non-small cell lung cancer patients with brain metastases harboring an ALK rearrangement demonstrated prolonged survival following treatment with the combination of an ALK-targeted tyrosine kinase inhibitor, including Alecensa (alectinib), and radiotherapy (PMID: 26438117).
|
26438117
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Alectinib
|
Guideline |
Actionable |
Alecensa (alectinib) is included in guidelines for patients with metastatic non-small cell lung cancer harboring an ALK rearrangement (PMID: 31987360, PMID: 30285222; ESMO.org).
|
31987360
30285222
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Alectinib
|
Phase II |
Actionable |
In a Phase II trial, Alecensa (alectinib) treatment was effective in treating non-small cell lung cancer patients with ALK rearrangement, resulting in a 50% (61/122) objective response rate (ORR) in all patients, a 45% (43/96) ORR in Crizotinib-refractory patients, and an 83% (70/84) CNS disease control rate (PMID: 26598747).
|
26598747
|
|
ALK rearrange
|
inflammatory myofibroblastic tumor
|
sensitive
|
Ceritinib
|
Guideline |
Actionable |
Zykadia (ceritinib) is included in guidelines for inflammatory myofibroblastic tumor patients with ALK translocations (NCCN.org).
|
detail...
|
|
ALK rearrange
|
Advanced Solid Tumor
|
sensitive
|
ASP3026
|
Phase I |
Actionable |
In a Phase I trial, ASP3026 treatment resulted in a partial response in 50% (8/16) and stable disease in 44% (7/16) of patients with an advanced solid tumor harboring an ALK rearrangement or ALK F1174L (PMID: 26966027; NCT01284192).
|
26966027
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
no benefit
|
Osimertinib
|
Guideline |
Actionable |
EGFR tyrosine kinase inhibitors including Tarceva (erlotinib), Iressa (gefitinib), Gilotrif (afatinib), and Tagrisso (osimertinib) are not indicated for use as subsequent therapy in ALK rearranged non-small cell lung cancer patients who relapsed on Alecensa (alectinib), Xalkori (crizotinib), or Zykadia (ceritinib) (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
no benefit
|
Ipilimumab + Nivolumab
|
Guideline |
Actionable |
Immune checkpoint inhibitors including Keytruda (pembrolizumab), Tecentriq (atezolizumab), and the combination of Opdivo (nivolumab) and Yervoy (ipilimumab) are not indicated for use as initial systemic therapy in non-small cell lung cancer patients harboring oncogenes, including ALK rearrangement (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung adenocarcinoma
|
predicted - sensitive
|
CT-707
|
Phase I |
Actionable |
In a Phase I trial, Conteltinib (CT-707) demonstrated safety and preliminary efficacy, resulting in an overall response rate of 77% (10/13, 1 complete response, 9 partial responses) and a disease control rate of 85% (11/13) in patients with ALK-rearranged lung adenocarcinoma (n=12) or malignant pleural mesothelioma (n=1), median progression-free survival was 13 months in patients with lung adenocarcinoma (PMID: 32181989).
|
32181989
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
no benefit
|
Durvalumab
|
Guideline |
Actionable |
Immune checkpoint inhibitors including Opdivo (nivolumab), Keytruda (pembrolizumab), Tecentriq (atezolizumab), and Imfinzi (durvalumab) are not indicated for use as subsequent therapy in non-small cell lung cancer patients with ALK rearrangement (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
no benefit
|
Durvalumab
|
Clinical Study - Cohort |
Actionable |
In a retrospective analysis, PD-1/PD-L1 inhibitors (Opdivo (nivolumab), Keytruda (pembrolizumab), Imfinzi (durvalumab), or Tecentriq (atezolizumab)) resulted in lower objective response rate (3.6%, 1/28) in non-small cell lung cancer patients harboring EGFR mutations (22/28) or ALK rearrangement (6/28) compared to EGFR wild-type, ALK negative/unknown patients (23.3%, 7/30) (PMID: 27225694).
|
27225694
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
no benefit
|
Afatinib
|
Guideline |
Actionable |
EGFR tyrosine kinase inhibitors including Tarceva (erlotinib), Iressa (gefitinib), Gilotrif (afatinib), and Tagrisso (osimertinib) are not indicated for use as subsequent therapy in ALK rearranged non-small cell lung cancer patients who relapsed on Alecensa (alectinib), Xalkori (crizotinib), or Zykadia (ceritinib) (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Ceritinib
|
Guideline |
Actionable |
Zykadia (ceritinib) is included in guidelines for patients with metastatic non-small cell lung cancer harboring an ALK rearrangement (PMID: 31987360, PMID: 30285222; ESMO.org).
|
detail...
30285222
31987360
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Ceritinib
|
Phase II |
Actionable |
In a Phase II trial (ASCEND-2), non-small cell lung cancer patients with brain metastases harboring an ALK rearrangement and previously treated with Xalkori (crizotinib) and chemotherapy demonstrated an overall response rate of 38.6% (54/140), a disease control rate of 77.1%, a median time to response of 1.8 months, a median duration of response of 9.7 months, and a median progression-free survival of 5.7 months when treated with Zykadia (ceritinib) (PMID: 27432917; NCT01685060).
|
27432917
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Ceritinib
|
Clinical Study - Cohort |
Actionable |
In a retrospective analysis, non-small cell lung cancer patients with brain metastases harboring an ALK rearrangement demonstrated a median overall survival of 49.5 months following treatment with the combination of an ALK-targeted tyrosine kinase inhibitor, including Zykadia (ceritinib), and radiotherapy (PMID: 26438117).
|
26438117
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Ceritinib
|
Guideline |
Actionable |
Zykadia (ceritinib) is included in guidelines as first-line and as subsequent therapy for patients with advanced or metastatic ALK-rearranged non-small cell lung cancer (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Ceritinib
|
FDA approved - On Companion Diagnostic |
Actionable |
In a Phase I trial that supported FDA approval, Zykadia (ceritinib) resulted in a blinded independent review committee (BIRC)-assessed objective response rate of 44% (72/163) and a duration of response of 7.1 months in ALK-rearranged non-small cell lung cancer patients (PMID: 25754348; NCT01283516).
|
25754348
detail...
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Lorlatinib
|
FDA approved - On Companion Diagnostic |
Actionable |
In a Phase II trial that supported FDA approval, Lorbrena (lorlatinib) treatment resulted in an objective response (OR) rate of 47% (93/198; 4 CR, 89 PR) and a median time to overall first tumor response of 1.4 months, and an objective intracranial response rate of 63% (51/81) and median time to first intracranial response of 1.4 months in ALK-positive (rearrangement or fusion) non-small cell lung cancer patients who had received at least one prior ALK inhibitor therapy (PMID: 30413378; NCT01970865).
|
detail...
detail...
30413378
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Lorlatinib
|
FDA approved - On Companion Diagnostic |
Actionable |
In a Phase III trial (Study B7461006) that supported FDA approval, Lorbrena (lorlatinib) treatment significantly improved 12-month progression-free survival rate (78% vs 39%, HR 0.28, p<0.001) compared to Xalkori (crizotinib) in patients with advanced ALK-positive non-small cell lung cancer who had no prior systemic therapy, objective response rate was 82% (57/69) with 71% achieved complete intracranial response in patients with brain metastasis (PMID: 33207094; NCT03052608).
|
33207094
detail...
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Lorlatinib
|
Guideline |
Actionable |
Lorbrena (lorlatinib) is included in guidelines for patients with metastatic non-small cell lung cancer harboring an ALK rearrangement who have progressed on a second-generation ALK tyrosine kinase inhibitor (PMID: 31987360, PMID: 30285222; ESMO.org).
|
30285222
detail...
31987360
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Lorlatinib
|
Phase I |
Actionable |
In a Phase I trial, Lorbrena (lorlatinib) treatment resulted in an objective response in 46% (19/41) of patients with non-small cell lung carcinoma harboring an ALK rearrangement (PMID: 29074098; NCT03052608).
|
29074098
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Lorlatinib
|
Guideline |
Actionable |
Lorbrena (lorlatinib) is included in guidelines as first-line therapy for patients with advanced or metastatic ALK-rearranged non-small cell lung cancer, and as subsequent therapy in patients who have progressed on Xalkori (crizotinib) and Alecensa (alectinib), Alunbrig (brigatinib), or Zykadia (ceritinib), or on Alecensa (alectinib), Alunbrig (brigatinib), or Zykadia (ceritinib) (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
no benefit
|
Erlotinib
|
Guideline |
Actionable |
EGFR tyrosine kinase inhibitors including Tarceva (erlotinib), Iressa (gefitinib), Gilotrif (afatinib), and Tagrisso (osimertinib) are not indicated for use as subsequent therapy in ALK rearranged non-small cell lung cancer patients who relapsed on Alecensa (alectinib), Xalkori (crizotinib), or Zykadia (ceritinib) (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
predicted - sensitive
|
PLB1003
|
Phase I |
Actionable |
In a Phase Ia trial, PLB1003 demonstrated safety and preliminary efficacy, resulted in a disease control rate of 86% (12/14, 10 partial response, 2 stable disease) in patients with ALK-rearranged non-small cell lung cancer who progressed on or did not tolerate previous treatment (Journal of Thoracic Oncology, Volume 14, Issue 10, S651).
|
detail...
|
|
ALK rearrange
|
Advanced Solid Tumor
|
sensitive
|
Belizatinib
|
Phase Ib/II |
Actionable |
In a Phase I trial, Belizatinib (TSR-011) treatment resulted in a response in 100% (3/3) of patients with ALK-rearranged advanced solid tumors when administered at higher doses, and stable disease for 7 months or longer in 56% (5/9) of patients at a lower dose (J Clin Oncol 33, 2015 (suppl; abstr 8063)).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Brigatinib
|
FDA approved - Has Companion Diagnostic |
Actionable |
In a Phase III trial (ALTA-1L) that supported FDA approval, Alunbrig (brigatinib) treatment resulted in superior progression-free survival (HR=0.49, p=0.0007) compared to Xalkori (crizotinib) in patients with ALK-rearrangement positive metastatic non-small cell lung cancer (Ann Oncol., Apr 2019, 30 (Suppl 2):ii48; NCT02737501).
|
detail...
detail...
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Brigatinib
|
FDA approved - Has Companion Diagnostic |
Actionable |
In a Phase II trial (ALTA) that supported FDA approval, Alunbrig (brigatinib) treatment resulted in an overall response rate of 45% (51/112) in the 90mg arm and 54% (59/110) in the 180mg arm, and median progression-free survival of 9.2 and 11.0 months respectively, in ALK-rearranged (fusion) non-small cell lung carcinoma patients who progressed on Xalkori (crizotinib) (PMID: 28475456; NCT02094573).
|
detail...
28475456
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Brigatinib
|
Guideline |
Actionable |
Alunbrig (brigatinib) is included in guidelines for patients with metastatic non-small cell lung cancer harboring an ALK rearrangement (PMID: 31987360, PMID: 30285222; ESMO.org).
|
detail...
31987360
30285222
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Brigatinib
|
Phase Ib/II |
Actionable |
In a Phase I/II trial, Alunbrig (brigatinib) treatment resulted in an objective response rate of 100% (8/8) in ALK inhibitor-naive, ALK-rearranged non-small cell lung cancer (NSCLC) patients, 72% (51/71) in Xalkori (crizotinib) treated ALK-rearranged NSCLC patients, and 83% (5/6) in ALK-rearranged NSCLC patients with CNS metastases (PMID: 27836716; NCT01449461).
|
27836716
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Brigatinib
|
Clinical Study |
Actionable |
In a retrospective analysis, Alunbrig (brigatinib) demonstrated limited efficacy, resulting in an objective response rate of 17% (3/18) and stable disease in 50% (9/18) of patients with Alecensa (alectinib) refractory, ALK-positive non-small cell lung cancer, with a median progression-free survival of 4.4 months (PMID: 29935304).
|
29935304
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Brigatinib
|
Clinical Study - Cohort |
Actionable |
In a retrospective analysis, non-small cell lung cancer patients with brain metastases harboring an ALK rearrangement demonstrated prolonged survival following treatment with the combination of an ALK-targeted tyrosine kinase inhibitor, including Alunbrig (brigatinib), and radiotherapy (PMID: 26438117).
|
26438117
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Brigatinib
|
Guideline |
Actionable |
Alunbrig (brigatinib) is included in guidelines as first-line and subsequent therapy for patients with advanced or metastatic ALK-rearranged non-small cell lung cancer (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
no benefit
|
Gefitinib
|
Guideline |
Actionable |
EGFR tyrosine kinase inhibitors including Tarceva (erlotinib), Iressa (gefitinib), Gilotrif (afatinib), and Tagrisso (osimertinib) are not indicated for use as subsequent therapy in ALK rearranged non-small cell lung cancer patients who relapsed on Alecensa (alectinib), Xalkori (crizotinib), or Zykadia (ceritinib) (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung adenocarcinoma
|
predicted - sensitive
|
Bevacizumab + Lorlatinib
|
Case Reports/Case Series |
Actionable |
In a clinical case study, a lung adenocarcinoma patient with brain metastasis harboring an ALK rearrangement, who had progressed on single agent Lorbrena (lorlatinib) treatment, demonstrated a partial response when treated with a combination of Lorbrena (lorlatinib) and Avastin (bevacizumab), with a 68% decrease in tumor size in the brain and a total duration of disease control for 9.1 months (PMID: 33283131).
|
33283131
|
|
ALK rearrange
|
anaplastic large cell lymphoma
|
sensitive
|
Crizotinib
|
FDA approved |
Actionable |
In a Phase I/II trial that supported FDA approval, Xalkori (crizotinib) treatment resulted in an objective response rate (ORR) of 83% (5/6, all complete responses (CR)) at the 165 mg dose, and an ORR of 90% (18/20, 16 CR) at the 280 mg dose, in pediatric patients 1 years of age or older and young adults with relapsed or refractory ALK-positive anaplastic large cell lymphoma (PMID: 28787259; NCT00939770).
|
28787259
detail...
|
|
ALK rearrange
|
anaplastic large cell lymphoma
|
sensitive
|
Crizotinib
|
Guideline |
Actionable |
Xalkori (crizotinib) is included in guidelines as second-line and subsequent therapy for patients with anaplastic large cell lymphoma harboring ALK rearrangements (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
no benefit
|
Pembrolizumab
|
Guideline |
Actionable |
Immune checkpoint inhibitors including Opdivo (nivolumab), Keytruda (pembrolizumab), Tecentriq (atezolizumab), and Imfinzi (durvalumab) are not indicated for use as subsequent therapy in non-small cell lung cancer patients with ALK rearrangement (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
no benefit
|
Pembrolizumab
|
Clinical Study - Cohort |
Actionable |
In a retrospective analysis, PD-1/PD-L1 inhibitors (Opdivo (nivolumab), Keytruda (pembrolizumab), Durvalumab (MEDI4736), or Tecentriq (atezolizumab)) resulted in lower objective response rate (3.6%, 1/28) in non-small cell lung cancer patients harboring EGFR mutations (22/28) or ALK rearrangement (6/28) compared to EGFR wild-type, ALK negative/unknown patients (23.3%, 7/30) (PMID: 27225694).
|
27225694
|
|
ALK rearrange
|
Advanced Solid Tumor
|
sensitive
|
Entrectinib
|
Phase I |
Actionable |
In a clinical study, combined analysis of 2 Phase I trials showed Rozlytrek (entrectinib) treatment resulted in an objective response rate of 57% (4/7) in patients with ALK rearranged advanced solid tumors that were treatment-naive, but no response (0/19) in patients who received prior Alk inhibitor treatments (PMID: 28183697).
|
28183697
|
|
ALK rearrange
|
Advanced Solid Tumor
|
sensitive
|
Entrectinib
|
Phase I |
Actionable |
In a Phase I trial, Rozlytrek (entrectinib) treatment resulted in objective response in 67% (4/6) of patients with advanced solid tumors harboring rearrangement in ALK gene (AACR Apr 2016, Abstract # CT007).
|
detail...
|
|
ALK rearrange
|
inflammatory myofibroblastic tumor
|
sensitive
|
Brigatinib
|
Guideline |
Actionable |
Alunbrig (brigatinib) is included in guidelines for inflammatory myofibroblastic tumor patients with ALK translocations (NCCN.org).
|
detail...
|
|
ALK rearrange
|
lung non-small cell carcinoma
|
sensitive
|
Ceritinib + Crizotinib
|
Clinical Study - Cohort |
Actionable |
In a retrospective analysis of patients with ALK-rearrangement positive non-small cell lung cancer, the combined median progression-free survival for sequential treatment with Xalkori (crizotinib) and Zykadia (ceritinib) without intervening treatments was 17.0 months, and overall survival was 49.4 months (PMID: 25724526).
|
25724526
|
|
ALK rearrange
|
inflammatory myofibroblastic tumor
|
sensitive
|
Crizotinib
|
Guideline |
Actionable |
Xalkori (crizotinib) is included in guidelines for inflammatory myofibroblastic tumor patients with ALK translocations (NCCN.org).
|
detail...
|
|
ALK rearrange
|
inflammatory myofibroblastic tumor
|
sensitive
|
Crizotinib
|
Case Reports/Case Series |
Actionable |
In a Phase I/II trial, Xalkori (crizotinib) treatment was well-tolerated and resulted in a partial response in 3 of 7 pediatric patients with ALK-rearranged inflammatory myofibroblastic tumors, and 3 of the 7 patients achieved stable disease (PMID: 23598171; NCT00939770).
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23598171
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ALK rearrange
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lung non-small cell carcinoma
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sensitive
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Ensartinib
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Clinical Study - Cohort |
Actionable |
In a retrospective analysis, non-small cell lung cancer patients with brain metastases harboring an ALK rearrangement demonstrated prolonged survival following treatment with the combination of an ALK-targeted tyrosine kinase inhibitor, including Ensartinib (X-396), and radiotherapy (PMID: 26438117).
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26438117
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ALK rearrange
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lung non-small cell carcinoma
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sensitive
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Ensartinib
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Phase Ib/II |
Actionable |
In a Phase I/II trial, Ensartinib (X-396) treatment resulted in partial response in 60% (36/60) and stable disease in 21.7 % (13/60) of patients with ALK-positive non-small cell lung cancer, with a median progression-free survival of 9.2 months, and a response rate of 80% (12/15) in crizotinib-naïve patients and 69% (20/29) in patients with prior crizotinib treatment (PMID: 29563138; NCT01625234).
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29563138
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ALK rearrange
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lung non-small cell carcinoma
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sensitive
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Ensartinib
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Phase III |
Actionable |
In a Phase III trial, Ensartinib (X-396) treatment significantly improved progression-free survival in patients with ALK-positive non-small cell lung cancer (25.8 vs 12.7 mo, HR 0.51, p<0.001) compared to Xalkori (crizotinib), and resulted in an intracranial response rate of 63.6% (7 of 11) in patients with target brain metastases at baselinewith compared to 21.1% (4 of 19) with Xalkori (crizotinib) (PMID: 34473194; NCT02767804).
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34473194
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ALK rearrange
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lung non-small cell carcinoma
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no benefit
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Atezolizumab
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Guideline |
Actionable |
Immune checkpoint inhibitors including Opdivo (nivolumab), Keytruda (pembrolizumab), Tecentriq (atezolizumab), and Imfinzi (durvalumab) are not indicated for use as subsequent therapy in non-small cell lung cancer patients with ALK rearrangement (NCCN.org).
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detail...
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ALK rearrange
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lung non-small cell carcinoma
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no benefit
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Atezolizumab
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Clinical Study - Cohort |
Actionable |
In a retrospective analysis, PD-1/PD-L1 inhibitors (Opdivo (nivolumab), Keytruda (pembrolizumab), Durvalumab (MEDI4736), or Tecentriq (atezolizumab)) resulted in lower objective response rate (3.6%, 1/28) in non-small cell lung cancer patients harboring EGFR mutations (22/28) or ALK rearrangement (6/28) compared to EGFR wild-type, ALK negative/unknown patients (23.3%, 7/30) (PMID: 27225694).
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27225694
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ALK mutant
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lung non-small cell carcinoma
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no benefit
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Crizotinib + Onalespib
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Phase II |
Actionable |
In a Phase II trial, Onalespib (AT13387) and Xalkori (crizotinib) combination treatment did not significantly improve median progression free survival (269 vs 266 days) or objective response rate (55.4%, 38/68 vs 45.3%, 31/68) compared to Xalkori (crizotinib) single treatment in patients with non-small cell lung carcinoma harboring either an ALK mutation or ALK rearrangement (J Clin Oncol 34, 2016 (suppl; abstr 9059); NCT01712217).
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detail...
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ALK mutant
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lung non-small cell carcinoma
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no benefit
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Belizatinib
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Phase I |
Actionable |
In a Phase I trial, treatment with Belizatinib (TSR-011) in ALK inhibitor-naive non-small cell lung cancer patients (n=14) harboring either an ALK mutation, ALK amplification, or an ALK rearrangement resulted in a partial response in 6 patients and stable disease in 8 patients, however, it was determined that the drug resulted in limited efficacy and development of the drug was discontinued (PMID: 31217479; NCT02048488).
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31217479
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