NSCLC — SCE Medical Oncology MCQ

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HardLung CancerNSCLCSCE Medical Oncology

An ALK-positive NSCLC develops intracranial and systemic progression after first-line alectinib. Re-biopsy is not safely feasible. Which next ALK inhibitor matches NICE TA628 and is designed to retain CNS activity after a second-generation inhibitor?

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Correct answer: D — Lorlatinib

NICE TA628 recommends lorlatinib after progression on alectinib or ceritinib used as the first ALK inhibitor. Lorlatinib has CNS activity and activity against several resistance mutations. Crizotinib and ceritinib are earlier ALK inhibitors; entrectinib targets ROS1/NTRK and osimertinib targets EGFR.

Reference: NICE TA628: lorlatinib after ALK inhibitor therapy. https://www.nice.org.uk/guidance/ta628/chapter/1-Recommendations