But it’s not the first choice now. Lorlatinib is due to its prolonged initial control in the CROWN study (longer than it’s expected sequential control if its used second line)
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Lorlatinib hasn’t suddenly become better tolerated or easier to give based on its labeled starting dose (but that’s another story). The issue is should anyone on brigatinib or alectinib or anything else other than lorlatinib in the first line switch to lorlatinib even if they are doing well?
The answer is, it depends, for every initial ALK tki there is a population that does really really well for a long time. The good ALKs or gALKs. Look at that crown data again. There are gALKs even with crizotinib (green box).
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