Crizotinib: A comprehensive review

Abstract

Anaplastic lymphoma kinase (ALK) gene rearrangements are present in a small subset of non-small-cell lung cancers. ALK-positivity confers sensitivity to small-molecule ALK kinase inhibitors, such as crizotinib. The integration of crizotinib into standard treatment practice in NSCLC will rest on the widespread implementation of an effective screening system for newly diagnosed patients with NSCLC which is flexible enough to incorporate new targets as treatments are developed for them. Phase I and II studies of crizotinib in ALK-positive lung cancer have demonstrated significant activity and impressive clinical benefit, which led to its early approval by USFDA in 2011. Although crizotinib induces remissions and extends the lives of patients, there have been reports of emerging resistance to Crizotinib therapy. In this review, we discuss the history, mechanism of action, uses, adverse effects, dose modifications and future challenges and opportunities for patients with ALK-positive lung cancers.

Keywords: ALK inhibitors; ALK mutation; ALK positive Non-small cell lung cancer; Crizotinib.

Figure 1

Diagrammatic representation of the structure of Crizotinib. Represented with permission and license from Elsevier Limited

Figure 2

Fluorescent in situ hybridization showing split red and green signals that flank the ALK translocation site in a tissue specimen showing EML4-ALK positive mutation as shown by white arrows