Combining LCT and Brigatinib May Benefit Patients With ALK+ NSCLC
David P. Carbone, MD, PhD, The Ohio State University Comprehensive Cancer Center Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, comments on a study evaluating the use of LCT plus brigatinib for patients with ALK-positive non–small-cell lung cancer (NSCLC).
I'm David Carbone. I'm a thoracic medical oncologist and the Director of the Thoracic Oncology Center at Ohio State University in Columbus, Ohio. I would like to talk today a little bit about some of the recent progress in lung cancer.
The next study that I wanted to talk about was looking at local consolidative therapy with brigatinib. This is a study called BRIGHTSTAR, and the first author was Elamin. They showed that they tackled the problem that most patients treated with ALK inhibitors, even though they get good responses, most don't get complete responses.
The question they asked here was, if you have a countable number of persistent lesions after treating with brigatinib, whether you could do local, consolidated therapy. That would be primarily radiation but sometimes, surgery, surgery and radiation, etc.
They showed that it's safe to do this local consolidation, and their preliminary data showed that there was maybe an effect on outcomes by doing this kind of approach.
This is actually similar to another study that was done in EGFR‑mutant disease that was also presented at ASCO. This was a study (with the first author, Wang) on tyrosine kinase inhibitors (TKIs), with or without radiation therapy in the embolic metastatic disease. They actually showed an improvement in both overall survival and progression‑free survival, with the SBRT plus the TKI.
I think that is increasingly becoming an accepted strategic. TKI therapies, or many therapies now, if you have oligo-progressive disease, radiating just the site of progression seems to be effective at maintaining the patient on the TKI or the immunotherapy for longer.
But this is actually a randomized study that shows that there appears to be a survival benefit to treating oligoresidual disease after TKI.
So, I think that the randomized study is in the setting of EGFR. But this BRIGHTSTAR trial, in the setting of ALK is only a single‑arm study, but I think it suggests that aggressive, local therapy with the TKI may be advantageous.
Now one of the other exciting things that has happened recently is the press release on the ADAURA trial. That's adjuvant, again, TKI in EGFR‑mutant disease that showed a dramatic improvement in disease‑free survival after surgery with adjuvant osimertinib.
I think the survival data is still immature in that study, but again, it speaks to local plus systemic therapy in these diseases.