5
ALK First-line
Recommendation 3.1
➤ For patients with an ALK rearrangement, a PS of 0-2, and
previously untreated NSCLC, clinicians should offer alectinib or
brigatinib (Strong recommendation; EB-B-H) or lorlatinib (Weak
recommendation; EB-B-L).
Recommendation 3.2
➤ For patients with an ALK rearrangement, a PS of 0-2, and previously
untreated NSCLC, if alectinib, brigatinib or lorlatinib are not
available, clinicians should offer ceritinib or crizotinib (Strong
recommendation; EB-B-H).
ALK Second-line
Recommendation 4.1
➤ For patients with an ALK rearrangement, a performance status of 0–2,
and have previously received alectinib or brigatinib, clinicians may
offer lorlatinib (Moderate recommendation; IC-L).
Recommendation 4.2
➤ For patients with an ALK rearrangement, a performance status of
0–2, and have previously received crizotinib in the first-line setting,
clinicians should offer alectinib, brigatinib, or ceritinib in the second-
line setting (Strong recommendation; EB-B-I).
Recommendation 4.3
➤ For patients with an ALK rearrangement, a performance status of 0–2,
and have received prior crizotinib in the first-line setting and either
alectinib, brigatinib, or ceritinib in the second-line setting, clinicians
may offer lorlatinib (Moderate recommendation; IC-L) or clinicians
may offer standard therapy based on the ASCO/OH non-driver
mutation guideline in the third-line setting (Weak recommendation;
IC-L).
