Response to Crizotinib Rechallenge after Initial Progression and Intervening Chemotherapy in ALK Lung Cancer

Non–Small Cell Lung Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

“…For patients who experience disease progression on crizotinib, subsequent treatment for ALK-positive NSCLC includes ceritinib or alectinib (see "Ceritinib" and "Alectinib," pages 521 and 522, and NSCL-21, page 510). 87,95,111,112 Continuing crizotinib may also be appropriate for patients whose disease progresses on crizotinib.…”

Clinical impact of sequential treatment with ALK-TKIs in patients with advanced ALK-positive non-small cell lung cancer: Results of a multicenter analysis

“…It is likely that the high anti-tumor activity observed with a 2nd ALK-TKI in our study is partly due to the selection of a population "enriched" for sensitivity to ALK-inhibition, since 16 out of the 22 patients (72.7%) treated with a 2nd ALK-TKI had responded to prior crizotinib. In addition, all 3 patients who received a 2nd ALK-TKI following an intervening systemic treatment responded to treatment, which might have contributed to the higher response rate observed, possibly because of a 're-treatment effect' (i.e., regain of sensitivity to an ALK-TKI following a drug-free interval) [25,26].…”

Response to Chemotherapy, Reexposure to Crizotinib and Treatment with a Novel ALK Inhibitor in a Patient with Acquired Crizotinib Resistance

“…Previous publications regarding the retreatment of patients with secondary resistance to EGFR-TKIs suggest that a drug holiday and treatment with a conventional chemotherapeutic may reestablish sensitivity to TKIs [9,10]. Although this strategy is well described for EGFR-TKIs, there is to date only one case report indicating that crizotinib retreatment of ALK-positive patients after a drug holiday and chemotherapy improves crizotinib sensitivity [11]. This case report illustrates that patients with secondary resistance to crizotinib can benefit from a range of therapeutic strategies, including drug holiday, chemotherapy, retreatment with crizotinib and treatment with new ALK inhibitors in clinical trials.…”