NCCN Guidelines for Patients® | Lung Cancer - Non-Small Cell Lung Cancer

85 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 ALK gene rearrangement Guide 22 lists treatment options for ALK gene rearrangements. These options may help you no matter your performance status. First-line treatment You may have three options. The preferred option of NCCN experts is alectinib. Other options are crizotinib or ceritinib. These treatments are targeted therapies. The ALK mutation may be found while you are on first-line chemotherapy. In this case, you may stop chemotherapy early and start targeted therapy. Otherwise, you may start targeted therapy as a maintenance treatment after completing chemotherapy. Next-in-line treatment The cancer may worsen while on first-line treatment. If the cancer doesn’t worsen much, one option may be to stay on first-line treatment. Local treatment may be added. It is sometimes used when the metastasis is within a confined area. Examples of these areas are the brain or adrenal gland. If you need to switch treatment, ceritinib, alectinib, or brigatinib are options after taking crizotinib. Local treatment may be added in this case, too. Platinum-based chemotherapy may be another option. It is often used if there are multiple metastatic tumors causing symptoms. Read Guide 26 to learn more options for Adenocarcinoma, large cell, and unknown types . Read Guide 27 to learn more options for Squamous cell carcinoma . 7 Metastatic cancer ALK gene rearrangement Guide 22. Treatment for ALK gene rearrangement First-line treatment What are the options? • Alectinib (preferred) • Crizotinib • Ceritinib Next-in-line treatment What are the options? • Stay on first-line treatment ± local treatment • Switch from crizotinib to ceritinib, alectinib, or brigatinib ± local treatment • Start treatment for histologic type ◦◦ Adenocarcinomas, large cell, unknown types (see Guide 26 ) ◦◦ Squamous cell carcinoma (see Guide 27 )

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