Canadian Perspectives Revisited: Consensus on the management of ALK-rearranged NSCLC

Inhibition of the anaplastic lymphoma kinase (ALK) oncogenic driver in advanced non-small cell lung carcinoma (NSCLC) improves survival. In 2016 and 2018, Canadian thoracic oncology specialists published consensus on the identification and treatment of ALK-rearranged patients, recommending use of first- and second-generation ALK inhibitors, as initial and subsequent treatment in the advanced setting. New scientific literature warrants a consensus update. ALK inhibitor pivotal and phase III clinical trials were reviewed to assess benefits, risks, and implications relative to current Canadian guidance for ALK-rearranged NSCLC patients. Updated Canadian recommendations for management of ALK-rearranged NSCLC:Our consensus recommendations highlight major developments in management of ALK-rearranged NSCLC and their relevance to the Canadian context. We strongly support upfront ALK testing, treatment of high-risk resected patients with adjuvant alectinib, and use of next-generation ALK inhibitors (lorlatinib, alectinib, brigatinib) as initial treatment of advanced patients.