Brigatinib for treatment of anaplastic lymphoma kinase-rearranged metastatic non-small cell lung cancer

Introduction: Crizotinib has been approved as a first-line treatment for patients with anaplastic lymphoma kinase (ALK)-rearranged advanced non-small-cell lung cancer (NSCLC). However, the majority of patients treated with crizotinib experience progression within 1 year, and the central nervous system (CNS) is the most common site of progression. Brigatinib, a potent and selective ALK inhibitor that can inhibit multiple crizotinib-resistant ALK mutants, has shown superior efficacy in advanced ALK-rearranged NSCLC, including in patients with CNS metastases. Areas covered: We reviewed the characteristics of brigatinib, and its clinical efficacy and safety have been demonstrated in previous pivotal studies. Expert opinion: Brigatinb was recently approved for use in ALK-rearranged NSCLC with acquired resistance to crizotinib as first-line treatment. Moreover, brigatinib is highly active in patients with CNS metastasis. The major concern about pulmonary adverse events was resolved with changes in treatment schedule. The mechanisms of resistance to brigatinib and the sequence of treatment with other ALK inhibitors are unresolved issues.