International Journal of Hematology and Oncology 2019, Vol 29, Num 3 Page(s): 60-68
Treatment After Crizotinib Resistance in ALK+ Non-Small-Cell Lung Cancer

Seher N. KAZAZ1, Ilhan OZTOP2

1Kanuni Research and Training Hospital, Medical Oncology, Trabzon, TURKEY
2Dokuz Eylül University, Institute of Oncology, Department of Medical Oncology, Izmir, TURKEY

Keywords: Non-small-cell lung cancer, ALK, Crizotinib, Resistance
Systemic chemotherapy, genotype-based targeted therapies and immunotherapy are widely used in the treatment of advanced nonsmall- cell lung cancer (NSCLC). Among the targeted therapies, the agents targeting the epidermal growth factor receptor (EGFR), the echinoderm microtubule-associated protein-like 4 anaplastic lymphoma kinase (EML4-ALK) rearrangement and C-ros oncogene 1 (ROS-1) have currently become standard treatment for cases presenting such molecular anomalies. Of them, cases with ALKrearrangement displayed dramatic results with a first generation ALK-inhibitor crizotinib; however, most of the patients develop a resistance in a few years. Especially the central nervous system relapses pose the most common clinical problem. Next generation ALK-inhibitors are promising with a high level of effectiveness in this resistance, in which various molecular mechanisms take part. Also, it gains increasing importance to re-perform a biopsy in the progression stage and reveal the mechanisms causing the secondary resistance in those patients.