Expanding the portfolio of anti-ALK weapons

The anaplastic lymphoma kinase (ALK) is a receptor tyrosine kinase involved in the onset of several malignancies. In particular, ALK is the driving oncogenic lesion in a small but significant fraction of nonsmall- cell lung cancer (NSCLC) patients. ALK+ NSCLCs can be treated with the dual ALK/MET inhibitor crizotinib, with better outcome compared to standard chemotherapy. However, relapses frequently occur, due to various mechanisms, limiting overall efficacy of the treatment. Point mutations within the ALK catalytic domain or ALK gene amplification account for approximately 30-40% of crizotinib-resistant cases, suggesting that the diseases still relies on ALK activity and that more potent inhibitors could be useful in this setting. Ceritinib is a novel selective ALK inhibitor with preclinical activity against crizotinib-resistant ALK mutants. A recent article in the New England Journal of Medicine reports on clinical evaluation of ceritinib. Response rate and progression-free survival (PFS) were comparable to crizotinib, but most importantly, crizotinib-resistant patients were successfully treated, with efficacy similar to crizotinib-naïve patients. The study extends the array of available anti-ALK drugs. Based on these data, ceritinib was approved by FDA in April 2014.