# Brigatinib versus Crizotinib in ALK-Positive Non-Small-Cell Lung Cancer

Source: https://onco.cc/key-papers/paper-alta-1l-n-engl-j-med-2018/  
OnCo record `paper-alta-1l-n-engl-j-med-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Published report from the ALTA-1L trial registered as NCT02737501, in New England Journal of Medicine (2018), chosen as the most cited paper whose own text cites the registry id.

## Summary

Background: Brigatinib, a next-generation anaplastic lymphoma kinase (ALK) inhibitor, has robust efficacy in patients with ALK-positive non-small-cell lung cancer (NSCLC) that is refractory to crizotinib. The efficacy of brigatinib, as compared with crizotinib, in patients with advanced ALK-positive NSCLC who have not previously received an ALK inhibitor is unclear.

Methods: In an open-label, phase 3 trial, we randomly assigned, in a 1:1 ratio, patients with advanced ALK-positive NSCLC who had not previously received ALK inhibitors to receive brigatinib at a dose of 180 mg once daily (with a 7-day lead-in period at 90 mg) or crizotinib at a dose of 250 mg twice daily. The primary end point was progression-free survival as assessed by blinded independent central review. Secondary end points included the objective response rate and intracranial response. The first interim analysis was planned when approximately 50% of 198 expected events of disease progression or death had occurred.

Results: A total of 275 patients underwent randomization; 137 were assigned to brigatinib and 138 to crizotinib. At the first interim analysis (99 events), the median follow-up was 11.0 months in the brigatinib group and 9.3 months in the crizotinib group. The rate of progression-free survival was higher with brigatinib than with crizotinib (estimated 12-month progression-free survival, 67% [95% confidence interval {CI}, 56 to 75] vs. 43% [95% CI, 32 to 53]; hazard ratio for disease progression or death, 0.49 [95% CI, 0.33 to 0.74]; P<0.001 by the log-rank test). The confirmed objective response rate was 71% (95% CI, 62 to 78) with brigatinib and 60% (95% CI, 51 to 68) with crizotinib; the confirmed rate of intracranial response among patients with measurable lesions was 78% (95% CI, 52 to 94) and 29% (95% CI, 11 to 52), respectively. No new safety concerns were noted.

Conclusions: Among patients with ALK-positive NSCLC who had not previously received an ALK inhibitor, progression-free survival was significantly longer among patients who received brigatinib than among those who received crizotinib. (Funded by Ariad Pharmaceuticals; ALTA-1L ClinicalTrials.gov number, NCT02737501.).

Indexed on Europe PMC as PubMed record 30280657 (DOI 10.1056/nejmoa1810171). Its abstract cites the registry id NCT02737501, which is how it was matched to this trial; no figure has been checked by an editor.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Tags: europepmc-ingest
- Journal: New England Journal of Medicine
- Year: 2018
- DOI: 10.1056/nejmoa1810171
- Authors: Camidge DR, Kim HR, Ahn MJ, et al.
- What it means: This is the paper Europe PMC returns for registry id NCT02737501 with the most citations, so it is the natural first reading for anyone following the ALTA-1L trial. Read the abstract above alongside the trial page and the registry entry; the record was linked automatically and its figures have not been checked by hand.
- Caveats: Matched to the trial by the registry id cited in the Europe PMC record; the summary reproduces the record's abstract and no figure has been verified against the full paper.

## Sources

- N Engl J Med 2018: https://doi.org/10.1056/nejmoa1810171
- PubMed: https://pubmed.ncbi.nlm.nih.gov/30280657/
- Europe PMC: https://europepmc.org/article/MED/30280657
- ClinicalTrials.gov NCT02737501: https://clinicaltrials.gov/study/NCT02737501

## Connected records

- trials: [ALTA-1L](https://onco.cc/trials/alta-1l/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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