47 / 48
To wrap-up
•
ALK Fusion assessment must be performed before 1st line treatment decision in
advanced non-Squamous NSCLC, never or light smokers and young patients
•
Initial assesment should be with IHC and FISH confirmation but new techniques
(NGS, liquid biopsies..) are increasingly available
•
Rebiopsies and NGS could be used to increase knowledge of resistance mechanisms
and could be useful for individual therapeutic sequence decision
•
Initial staging and (follow-up) should include brain MRI
•
Patients with advanced NSCLC ALK+ must receive 1st line therapy with ALK-TKIs
•
1st line treatment with Alectinib or Brigatinib is superior to Crizotinib with higher
efficacy in treatment or prevention of CNS metastases
•
2nd line treatment with Ceritinib, Alectinib or Brigatinib is superior to
chemotherapy in case of progression after Crizotinib
•
Local therapies should be considered for cases of oligometastatic progression
•
Sequential treatment and even retreatment with ALK-TKIs seems to be a key factor
to achieve long-term survivors in NSCLC ALK+