56. ALK-mutant Metastatic Lung Cancer

In this episode, Michael and Josh step onto the oncological Nautilus, to begin their journey 20,000 Leagues Under Lung Cancer, to examine non-small cell lung cancer with mutations other than EGFR. The first step on their journey is discussing the anaplastic lymphoma kinase, a tyrosine kinase inhibitor associated with the development of non-small cell lung cancer in younger patients who have never smoked. Thankfully, unlike their previous episode, there are treatment options galore for patients with ALKmut NSCLC. Two of the contenders for the title of "The King of the ALK" are alectinib and lorlatinib. Alectinib has more robust overall survival data, but lorlatinib has hazard ratios so ridiculously good that they would almost meet statistical significance as p values! So which is better? Listen on to find out.

Links to studies discussed in this episode (subscription may be required):

ALEX: https://www.nejm.org/doi/full/10.1056/nejmoa1704795

CROWN: https://www.nejm.org/doi/full/10.1056/NEJMoa2027187

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