Alectinib vs. Crizotinib for ALK-Positive Non–Small-Cell Lung Cancer

The J-ALEX trial was a phase III, open-label study comparing two anaplastic lymphoma kinase (ALK) inhibitors — crizotinib, the current standard first-line therapy for non–small-cell lung cancer (NSCLC), and alectinib — in 207 Japanese ALK-inhibitor–naive patients with ALK-positive NSCLC. Patients either had not received chemotherapy or had received a single regimen. They were randomized to alectinib (300 mg twice daily) or crizotinib (250 mg twice daily). The study was sponsored by the manufacturer of alectinib.

Alectinib was superior to crizotinib for median progression-free survival (not reached vs. 10 months); the benefit was seen in patients receiving first-line therapy (NR vs. 10 months) and second-line therapy (20 vs. 8 months). The ov…