Formal discussant of the ALINA trial Marina C. Garassino, MD, of the University of Chicago, agreed these results are “impressive and practice changing.” However, she said, at this point, more consideration is needed before jettisoning chemotherapy.

Marina C. Garassino, MD

“I don’t think we should stop giving adjuvant chemotherapy in ALK-positive non–small cell lung cancer. Chemotherapy is the only treatment that demonstrated an increase of overall survival. Furthermore, pemetrexed is also a good ALK inhibitor and may even increase the benefit of adjuvant chemotherapy. We still don’t know the impact of alectinib on survival because it’s too early,” she continued.

“We have to remember that other trials, such as the RADIANT trial, had impressive disease-free survival with erlotinib that did not translate to an overall survival benefit. In ALINA, the majority of patients are still on treatment,” she noted.

“Also, in my patients’ experience on alectinib for metastatic disease, many report side effects such as difficulty focusing, neuropathy, sun sensitivity, constipation, and myalgia and 27% of patients interrupted treatment due to side effects,” Dr. Garassino said. “I will ask patients if they want this treatment in the absence of an overall survival benefit.”

DISCLOSURE: Dr. Garassino has received personal and/or institutional financial support from AbbVie, Abion, AstraZeneca, Bayer, BeiGenius, Blueprint, BMS, Boehringer Ingelheim Italia SpA, Celgene, Daiichi Sankyo, Eli Lilly, Foundation Medicine, GlaxoSmithKline, Ignyta, Incyte, IO Biotech, Janssen, MedImmune, Medscape, Merck, Mirati Therapeutics, MSD, MSD International GmbH, Novartis, Oncohost, Pfizer, Regeneron, Roche, Sanofi, Seattle Genetics, Spectrum Pharmaceuticals, Takeda, and Tiziana; has relationships with AIFA, AIRC, Italian Moh, and TRANSCAN; and has received research funding from Horizon 2020.