Vizimpro (dacomitinib) vs Xalkori (crizotinib)

Vizimpro (dacomitinib) and Xalkori (crizotinib) are both oral medications used to treat non-small cell lung cancer (NSCLC), but they target different genetic mutations. Vizimpro is a second-generation tyrosine kinase inhibitor (TKI) designed to inhibit the epidermal growth factor receptor (EGFR) with mutations that are common in NSCLC, and is typically used for first-line treatment. On the other hand, Xalkori is a first-generation TKI that targets ALK (anaplastic lymphoma kinase) and ROS1 (c-ros oncogene 1) rearrangements, which are less common but also present in some NSCLC patients; it is also used in first-line treatment for patients with these specific genetic profiles. When deciding between Vizimpro and Xalkori, it is crucial to have molecular testing to determine the presence of EGFR mutations or ALK/ROS1 rearrangements, as this will directly influence which medication is appropriate for an individual's cancer treatment.

Difference between Vizimpro and Xalkori

Metric	Vizimpro (dacomitinib)	Xalkori (crizotinib)
Generic name	Dacomitinib	Crizotinib
Indications	First-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 L858R substitution mutations	Treatment of metastatic NSCLC that is anaplastic lymphoma kinase (ALK) or ROS1-positive
Mechanism of action	Irreversible inhibitor of the EGFR family of tyrosine kinases	Inhibitor of ALK tyrosine kinase receptor and the c-Met/hepatocyte growth factor receptor
Brand names	Vizimpro	Xalkori
Administrative route	Oral	Oral
Side effects	Diarrhea, rash, paronychia, stomatitis, decreased appetite, dry skin, decreased weight, alopecia, cough, pruritus	Visual disorders, gastrointestinal effects, edema, elevated transaminases, fatigue, decreased appetite, upper respiratory infection, dizziness, neuropathy
Contraindications	None specifically listed; use caution in patients with severe renal impairment or moderate to severe hepatic impairment	Hepatic impairment or severe renal impairment
Drug class	Kinase inhibitor	Kinase inhibitor
Manufacturer	Pfizer	Pfizer

Efficacy

Vizimpro (dacomitinib) Efficacy in Lung Cancer

Vizimpro (dacomitinib) is a kinase inhibitor specifically designed to target the epidermal growth factor receptor (EGFR), which is a common mutation found in non-small cell lung cancer (NSCLC). Clinical trials have demonstrated that Vizimpro is effective in treating patients with metastatic NSCLC harboring EGFR exon 19 deletion or exon 21 L858R substitution mutations. The pivotal trial for Vizimpro's approval, ARCHER 1050, showed a significant improvement in progression-free survival (PFS) when compared to another EGFR inhibitor, gefitinib. Patients treated with Vizimpro had a median PFS of 14.7 months versus 9.2 months for those on gefitinib.

Moreover, Vizimpro has shown an overall survival benefit in the treatment of NSCLC with EGFR mutations. In the ARCHER 1050 study, the median overall survival for patients taking Vizimpro was 34.1 months, compared to 26.8 months for those on gefitinib. These results indicate that Vizimpro can be an effective first-line treatment option for patients with EGFR-mutated NSCLC.

Xalkori (crizotinib) Efficacy in Lung Cancer

Xalkori (crizotinib) is an anaplastic lymphoma kinase (ALK) inhibitor used to treat NSCLC that is ALK-positive. The effectiveness of Xalkori in treating ALK-positive NSCLC has been established through several clinical trials. In a randomized trial comparing Xalkori to chemotherapy in previously untreated ALK-positive NSCLC patients, Xalkori significantly prolonged PFS, with a median PFS of 10.9 months compared to 7 months for chemotherapy.

Additionally, Xalkori has demonstrated efficacy in patients who have received prior treatment. In a single-arm study of patients with ALK-positive NSCLC who had progressed on chemotherapy, treatment with Xalkori resulted in a response rate of approximately 50-60%, with a median duration of response ranging from 7.7 to 11.1 months. These findings support the use of Xalkori as a standard treatment for patients with ALK-positive NSCLC, both as a first-line therapy and after chemotherapy failure.

Regulatory Agency Approvals

Vizimpro

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA

Xalkori

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA
Health Canada
Pharmaceuticals and Medical Devices Agency (PMDA), Japan
Therapeutic Goods Administration (TGA), Australia

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