Medications known as ALK inhibitors are available to treat non-small cell lung cancer (NSCLC) with the ALK gene mutation. The drugs can help shrink or slow the growth of tumors in people with ALK+ NSCLC.
There are two main types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Most cases of lung cancer are NSCLC.
Different types of NSCLC result from different genetic changes in affected cells. According to the American Cancer Society,
The ALK gene provides instructions for producing anaplastic lymphoma kinase (ALK), a protein that helps regulate cell growth and division. The mutated gene causes affected cells to produce abnormal ALK, which helps them grow and spread.
This article discusses the types of ALK inhibitors and how they work, alongside their benefits and risks.
Scientists have developed multiple drugs that target abnormal ALK, including:
- crizotinib (Xalkori)
- ceritinib (Zykadia)
- alectinib (Alecensa)
- brigatinib (Alunbrig)
- lorlatinib (Lorbrena)
These ALK inhibitors are oral medications that bind to abnormal ALK protein, which blocks the protein from energy sources and deactivates it.
ALK inhibitors can help shrink or slow the growth of tumors in people with ALK+ NSCLC.
The treatment plan for lung cancer largely depends on whether the cancer has spread. A person’s overall health and the specific type of cancer they have may also affect their treatment plan.
If the cancer has not yet spread, a doctor will likely recommend surgery to remove it. In some cases, they may also prescribe medication, radiation therapy, or both to reduce the chances of the cancer returning after surgery.
If the cancer has spread, a doctor may prescribe other treatments that sometimes include a targeted therapy. The specific type of targeted therapy depends on the type of genetic changes in the cancer cells.
A doctor may prescribe an ALK inhibitor if:
- they cannot remove the cancer with surgery
- the cancer has spread to the lymph nodes or other parts of the body
- the cancer has continued to grow or returned after other treatments
- the cancer cells test positive for genetic changes in the ALK gene
Depending on a person’s treatment needs and preferences, their doctor may prescribe an ALK inhibitor on its own or with other treatments.
According to a 2019 review in Frontiers in Oncology, ALK inhibitors are more effective than chemotherapy for improving quality of life. They are also more effective at prolonging progression-free survival, which means that people who took ALK inhibitors in studies lived longer on average without the cancer worsening.
A
The 2019 review found that Alecensa, Alunbrig, and Zykadia were more effective than Xalkori for promoting quality of life and progression-free survival. The 2020 review found that Alecensa and Alunbrig were more effective than Xalkori and Zykadi in promoting progression-free survival. Neither review assessed Lorbrena, which is a newer drug.
A 2021 review in Cancers compared Lorbrena with other ALK inhibitors and found it was the most effective for promoting progression-free survival. However, Lorbrena also caused more severe adverse events.
Not all people respond to the same treatments in the same way. An ALK inhibitor that works well for one person may not work well for another. More research is necessary to compare different types of lung cancer treatments and learn which groups of people with ALK+ NLSCL are most likely to benefit from specific treatments.
A person can speak with their doctor to learn more about the potential benefits of different treatment options.
ALK inhibitors can cause side effects and adverse events, which are undesirable medical experiences that may happen during treatment.
The 2019 review in Frontiers in Oncology found that people who took ALK inhibitors reported more adverse events than those who received chemotherapy. However, those who took ALK inhibitors were less likely to stop treatment due to adverse events.
According to another
The 2021 review in Cancers found a higher risk of severe adverse events from Lorbrena than other ALK inhibitors.
Common side effects of ALK inhibitors include:
- nausea
- vomiting
- diarrhea
- constipation
- fatigue
- vision changes
Less common but more severe side effects include:
- inflammation in the lungs or other organs
- liver damage
- nerve damage
- abnormal heart rhythms
A person can speak with their doctor to learn more about the risks of side effects from different types of ALK inhibitors. The doctor can help them learn how to recognize and manage potential side effects. If an individual develops side effects that are difficult to manage, the doctor may recommend changes to their treatment plan.
A person’s doctor can also help them learn about drug resistance, which happens when a medication stops working over time. If one type of ALK inhibitor stops working, a doctor may prescribe another type of ALK inhibitor or other cancer treatment.
ALK inhibitors are a type of targeted therapy that can help prolong outlook and improve quality of life in people with ALK+ NSCLC that has spread from the original site of the cancer to the lymph nodes or other body parts.
Research suggests that ALK inhibitors are more effective than chemotherapy for prolonging progression-free survival and improving quality of life. Some ALK inhibitors may work better for certain people than for others.
A person can talk with their doctor to learn if an ALK inhibitor is a good treatment option for them. The doctor can help them understand the potential benefits and risks of different treatments.
If someone develops side effects that are difficult to manage or drug resistance to an ALK inhibitor or other therapy, a doctor may recommend changes to their treatment plan.