Discovering Insights Beyond Clinical Trials: Exploring ALK-Positive Lung Cancer Treatment

Clinical trials are the gold standard for evaluating new treatments in medicine. They offer a structured approach, where patient groups are carefully selected, treatments are administered, and results are meticulously followed over time. This controlled environment allows for a deep understanding of how treatments perform in specific patient populations, free from the confounding factors that might skew results.

However, clinical trials aren't the only source of valuable insights. Retrospective studies investigate the treatment outcomes of patients who have already undergone therapy, utilizing data from clinics or groups of clinics. Patient consent is typically sought at the onset of diagnosis and treatment, and patient data is stripped of identifying information. By analyzing this wealth of real-world data, researchers can glean invaluable insights, especially when clinical trial data is scarce or unavailable.

Retrospective studies hold particular significance in fields like ALK lung cancer, where innovative treatments are constantly emerging. For instance, consider scenarios where clinical trials haven't yet explored the efficacy of certain approaches, such as increasing the dose of alectinib for patients with relapsing brain metastases or combining chemotherapy with targeted therapies (TKIs). Retrospective data reviews in these examples have significantly influenced clinical practice.

At times, retrospective studies may even zoom in further, focusing on individual cases or small groups of patients. While these case studies may lack the statistical robustness of larger trials, they can still offer crucial insights, particularly when there's a need to urgently address treatment challenges. Take, for instance, the use of Avastin (bevacizumab) for ALK radiation necrosis—an approach initially explored through case reports before gaining broader attention.

For clinicians and researchers, access to a spectrum of evidence—from controlled clinical trials to retrospective analyses and even individual case reports—paves the way for personalized treatment strategies. By harnessing insights from diverse sources, healthcare providers can tailor therapies to individual patient needs, even in the absence of comprehensive trial data.

In the ever-evolving landscape of ALK lung cancer treatment, embracing a multifaceted approach to evidence can lead to more informed decisions, better patient outcomes, and ultimately, a brighter future in the fight against this challenging disease.

Cheung JM, Kang J, Yeap BY, et al. Efficacy and safety of dose-escalated alectinib in patients with metastatic ALK-positive NSCLC and central nervous system relapse on standard-dose alectinib. JTO Clin Res Rep. 2024;5:100645.

Lin JJ, Schoenfeld AJ, Zhu VW, Yeap BY, Chin E, Rooney M, Plodkowski AJ, Digumarthy SR, Dagogo-Jack I, Gainor JF, Ou SI, Riely GJ, Shaw AT. Efficacy of Platinum/Pemetrexed Combination Chemotherapy in ALK-Positive NSCLC Refractory to Second-Generation ALK Inhibitors. J Thorac Oncol. 2020 Feb;15(2):258-265. doi: 10.1016/j.jtho.2019.10.014. Epub 2019 Oct 26. PMID: 31669591; PMCID: PMC7058505.

Tanigawa K, Mizuno K, Kamenohara Y, Unoki T, Misono S, Inoue H. Effect of bevacizumab on brain radiation necrosis in anaplastic lymphoma kinase-positive lung cancer. Respirol Case Rep. 2019 Jun 24;7(7):e00454. doi: 10.1002/rcr2.454. PMID: 31285826; PMCID: PMC6590096.

Clinical Trials Currently Recruiting for ALK-positive Cancers.

ALK Positive, along with the University of Washington, is seeking more information about the experiences of those diagnosed with ALK-positive lung cancer. They have created a survey with many points of interest, including the experiences of those who have participated in clinical trials. The survey is confidential and approved by a research governing body. To complete the survey, please click here: ALK-positive Lung Cancer Registry and Survey

General Information About Clinical Trials

As of April 2024, there are at least 50 clinical trials that are recruiting specifically for people with ALK-positive lung cancer. Many of these trials have multiple sites worldwide. Since ALK-positive lung cancer is a rare disease, it is difficult for any one oncologist to be aware of all the trials available. You can advocate for yourself and find a clinical trial that may be a good fit for you at any juncture in treatment.

*The ALK Positive Clinical Trials Spreadsheet was developed by the ALK Positive Medical Committee. The database is updated monthly. Disclaimer: these trials have been consolidated by volunteers and should not be considered exhaustive. Listing of these trials is not an endorsement, and ALK Positive does not recommend one trial over another. Please talk with your doctor about these or any trials you are interested in.

By Ellee Urban with assistance from ChatGPT.