A few pills twice a day keep ALK-positive non-small-cell lung cancer at bay

Non-small-cell lung cancer (NSCLC) represents the paradigm of personalized treatment of human cancer. A number of oncogenic druggable alterations have been so far identified, with anaplastic lymphoma kinase (ALK) gene rearrangements being one of the most attractive (1). In the past 10 years, we have learned that the presence of such molecular event is associated with some specific pathological and clinical features, including a preferential seeding into the central nervous system (CNS) and, most importantly, anticipates response to anti-ALK agents (2-4). Front-line crizotinib, the first-in-class ALK-inhibitor, prolonged median progression-free survival (PFS) of 4 months respect to standard platinum-pemetrexed (11.9 versus 7.0 months; HR =0.45, P<0.001), nearly doubling the probability of achieving responses [response rate (RR): 75% versus 45%] and preserving quality of life, as demonstrated in the PROFILE 1014 trial (5).