ALK-positive non-small-cell lung cancer: lines of therapy
5 standard-of-care settings across 4 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Advanced, first line | Alectinib (ALEX), brigatinib (ALTA-1L) or lorlatinib (CROWN); lorlatinib gives the longest control and the best brain protection, with dose adjustment for cognitive, mood and metabolic effects. | NCCN Guidelines: Non-Small Cell Lung Cancer | 86 | |
| All comers | Advanced, after lorlatinib | Neladalkib in trials (ALKOVE-1); chemotherapy; clinical trial. | NCCN Guidelines: Non-Small Cell Lung Cancer | 86 |
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Advanced, after a second-generation inhibitor | Lorlatinib, guided where possible by the resistance mutation; local radiotherapy for oligoprogression; platinum-pemetrexed once inhibitors are exhausted. | NCCN Guidelines: Non-Small Cell Lung Cancer | 86 |
Special situations
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Brain metastases | Next-generation inhibitors control most brain metastases without radiotherapy; stereotactic radiosurgery for large or symptomatic lesions; whole-brain radiotherapy avoided. | NCCN Guidelines: Non-Small Cell Lung Cancer | 86 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Resected stage IB to IIIA | Surgery then two years of adjuvant alectinib (ALINA) in place of platinum chemotherapy. | NCCN Guidelines: Non-Small Cell Lung Cancer | 86 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.