Ceritinib vs. Chemotherapy for ALK-Positive Non–Small-Cell Lung Cancer

The optimal sequence of therapy for anaplastic lymphoma kinase (ALK)-positive non–small-cell lung cancer (NSCLC) is unknown.

To compare ceritinib — a second-generation oral ALK inhibitor with blood-brain barrier penetrance — with platinum-pemetrexed chemotherapy in this setting, investigators conducted an industry-funded, international, randomized, open-label, phase III trial (ASCEND-4) involving 376 treatment-naive patients metastatic ALK-positive NSCLC. Most patients who received chemotherapy (73%) also received maintenance pemetrexed.

Results were as follows:

• Progression-free survival (PFS; the primary endpoint) was prolonged with ceritinib versus chemotherapy (16.6 vs. 8.1 months; hazard ratio, 0.55; P<0.00001). Median PFS was even higher …