title: Canadian consensus: inhibition of ALK-positive tumours in advanced non-small-cell lung cancer.
abstract: Anaplastic lymphoma kinase (alk) is an oncogenic driver in non-small-cell lung cancer (nsclc). Chromosomal rearrangements involving the ALK gene occur in up to 4% of nonsquamous nsclc patients and lead to constitutive activation of the alk signalling pathway. ALK-positive nsclc is found in relatively young patients, with a median age of 50 years. Patients frequently have brain metastasis. Targeted inhibition of the alk pathway prolongs progression-free survival in patients with ALK-positive advanced nsclc. The results of several recent clinical trials confirm the efficacy and safety benefit of crizotinib and ceritinib in this population. Canadian oncologists support the following consensus statement: All patients with advanced nonsquamous nsclc (excluding pure neuroendocrine carcinoma) should be tested for the presence of an ALK rearrangement. If an ALK rearrangement is present, treatment with a targeted alk inhibitor in the first-line setting is recommended. As patients become resistant to first-generation alk inhibitors, other treatments, including second-generation alk inhibitors can be considered.
authors.affiliation: British Columbia: BC Cancer Agency, Vancouver Centre, Vancouver, BC (Melosky, Ionescu);
authors.forename: B
authors.initials: B
authors.lastname: Melosky
authors.affiliation: Quebec: Jewish General Hospital, McGill University, Montreal, QC (Agulnik); chum -Hôpital St-Luc, Montreal, QC (Albadine); chum -Hôpital Notre-Dame, Montreal, QC (Blais); Royal Victoria Hospital, Montreal, QC (Hirsh); Segal Cancer Centre and Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC (Cohen);
authors.forename: J
authors.initials: J
authors.lastname: Agulnik
authors.affiliation: Quebec: Jewish General Hospital, McGill University, Montreal, QC (Agulnik); chum -Hôpital St-Luc, Montreal, QC (Albadine); chum -Hôpital Notre-Dame, Montreal, QC (Blais); Royal Victoria Hospital, Montreal, QC (Hirsh); Segal Cancer Centre and Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC (Cohen);
authors.forename: R
authors.initials: R
authors.lastname: Albadine
authors.affiliation: Manitoba: CancerCare Manitoba and University of Manitoba, Winnipeg, MB (Banerji);
authors.forename: S
authors.initials: S
authors.lastname: Banerji
authors.affiliation: Alberta: Tom Baker Cancer Centre, Calgary, AB (Bebb); Cross Cancer Institute and University of Alberta, Edmonton, AB (Butts, Deschenes);
authors.forename: D G
authors.initials: DG
authors.lastname: Bebb
authors.affiliation: Nova Scotia: QEII Health Sciences Centre, Halifax, NS (Bethune, Morzycki, Xu);
authors.forename: D
authors.initials: D
authors.lastname: Bethune
authors.affiliation: Quebec: Jewish General Hospital, McGill University, Montreal, QC (Agulnik); chum -Hôpital St-Luc, Montreal, QC (Albadine); chum -Hôpital Notre-Dame, Montreal, QC (Blais); Royal Victoria Hospital, Montreal, QC (Hirsh); Segal Cancer Centre and Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC (Cohen);
authors.forename: N
authors.initials: N
authors.lastname: Blais
authors.affiliation: Alberta: Tom Baker Cancer Centre, Calgary, AB (Bebb); Cross Cancer Institute and University of Alberta, Edmonton, AB (Butts, Deschenes);
authors.forename: C
authors.initials: C
authors.lastname: Butts
authors.affiliation: Ontario: Sunnybrook Odette Cancer Centre, Toronto, ON (Cheema, Cheung); Juravinski Cancer Centre, Hamilton, ON (Juergens); University Health Network, Princess Margaret Cancer Centre, Toronto, ON (Kamel-Reid, Liu, Tsao); The Ottawa Hospital Cancer Centre, Ottawa, ON (Laurie).
authors.forename: P
authors.initials: P
authors.lastname: Cheema
authors.affiliation: Ontario: Sunnybrook Odette Cancer Centre, Toronto, ON (Cheema, Cheung); Juravinski Cancer Centre, Hamilton, ON (Juergens); University Health Network, Princess Margaret Cancer Centre, Toronto, ON (Kamel-Reid, Liu, Tsao); The Ottawa Hospital Cancer Centre, Ottawa, ON (Laurie).
authors.forename: P
authors.initials: P
authors.lastname: Cheung
authors.affiliation: Quebec: Jewish General Hospital, McGill University, Montreal, QC (Agulnik); chum -Hôpital St-Luc, Montreal, QC (Albadine); chum -Hôpital Notre-Dame, Montreal, QC (Blais); Royal Victoria Hospital, Montreal, QC (Hirsh); Segal Cancer Centre and Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC (Cohen);
authors.forename: V
authors.initials: V
authors.lastname: Cohen
authors.affiliation: Alberta: Tom Baker Cancer Centre, Calgary, AB (Bebb); Cross Cancer Institute and University of Alberta, Edmonton, AB (Butts, Deschenes);
authors.forename: J
authors.initials: J
authors.lastname: Deschenes
authors.affiliation: British Columbia: BC Cancer Agency, Vancouver Centre, Vancouver, BC (Melosky, Ionescu);
authors.forename: D N
authors.initials: DN
authors.lastname: Ionescu
authors.affiliation: Ontario: Sunnybrook Odette Cancer Centre, Toronto, ON (Cheema, Cheung); Juravinski Cancer Centre, Hamilton, ON (Juergens); University Health Network, Princess Margaret Cancer Centre, Toronto, ON (Kamel-Reid, Liu, Tsao); The Ottawa Hospital Cancer Centre, Ottawa, ON (Laurie).
authors.forename: R
authors.initials: R
authors.lastname: Juergens
authors.affiliation: Ontario: Sunnybrook Odette Cancer Centre, Toronto, ON (Cheema, Cheung); Juravinski Cancer Centre, Hamilton, ON (Juergens); University Health Network, Princess Margaret Cancer Centre, Toronto, ON (Kamel-Reid, Liu, Tsao); The Ottawa Hospital Cancer Centre, Ottawa, ON (Laurie).
authors.forename: S
authors.initials: S
authors.lastname: Kamel-Reid
authors.affiliation: British Columbia: BC Cancer Agency, Vancouver Centre, Vancouver, BC (Melosky, Ionescu);
authors.forename: S A
authors.initials: SA
authors.lastname: Laurie
authors.affiliation: British Columbia: BC Cancer Agency, Vancouver Centre, Vancouver, BC (Melosky, Ionescu);
authors.forename: G
authors.initials: G
authors.lastname: Liu
authors.affiliation: Nova Scotia: QEII Health Sciences Centre, Halifax, NS (Bethune, Morzycki, Xu);
authors.forename: W
authors.initials: W
authors.lastname: Morzycki
authors.affiliation: Ontario: Sunnybrook Odette Cancer Centre, Toronto, ON (Cheema, Cheung); Juravinski Cancer Centre, Hamilton, ON (Juergens); University Health Network, Princess Margaret Cancer Centre, Toronto, ON (Kamel-Reid, Liu, Tsao); The Ottawa Hospital Cancer Centre, Ottawa, ON (Laurie).
authors.forename: M S
authors.initials: MS
authors.lastname: Tsao
authors.affiliation: Nova Scotia: QEII Health Sciences Centre, Halifax, NS (Bethune, Morzycki, Xu);
authors.forename: Z
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Quebec: Jewish General Hospital, McGill University, Montreal, QC (Agulnik); chum -Hôpital St-Luc, Montreal, QC (Albadine); chum -Hôpital Notre-Dame, Montreal, QC (Blais); Royal Victoria Hospital, Montreal, QC (Hirsh); Segal Cancer Centre and Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC (Cohen);
authors.forename: V
authors.initials: V
authors.lastname: Hirsh
keywords: ALK; anaplastic lymphoma kinase; molecular testing; non-small-cell lung cancer; targeted inhibition