Alunbrig (brigatinib) vs Lorviqua (lorlatinib)

Alunbrig (brigatinib) and Lorviqua (lorlatinib) are both targeted therapies known as tyrosine kinase inhibitors used to treat non-small cell lung cancer (NSCLC) with specific genetic alterations, primarily ALK-positive tumors. Alunbrig is typically used after crizotinib failure and has shown high efficacy in inhibiting ALK mutations, including some resistant to first-line treatment. In contrast, Lorviqua is a third-generation ALK inhibitor that can be used after other ALK inhibitors have failed and is noted for its ability to penetrate the blood-brain barrier, potentially treating or preventing brain metastases more effectively. When deciding between the two, it is crucial to consider the specific mutation profile of the tumor, previous treatments, and the potential side effect profile of each medication, as well as consulting with a healthcare provider for personalized medical advice.

Difference between Alunbrig and Lorviqua

Metric	Alunbrig (brigatinib)	Lorviqua (lorlatinib)
Generic name	Brigatinib	Lorlatinib
Indications	Non-small cell lung cancer (NSCLC) with ALK mutations	Non-small cell lung cancer (NSCLC) with ALK or ROS1 mutations
Mechanism of action	ALK and EGFR inhibitor	ALK and ROS1 inhibitor
Brand names	Alunbrig	Lorviqua
Administrative route	Oral	Oral
Side effects	Nausea, diarrhea, fatigue, cough, headache	Edema, weight gain, cognitive effects, mood effects, hypercholesterolemia
Contraindications	Hypersensitivity to brigatinib	Hypersensitivity to lorlatinib
Drug class	Tyrosine kinase inhibitor	Tyrosine kinase inhibitor
Manufacturer	Takeda Pharmaceuticals	Pfizer

Efficacy

Alunbrig (brigatinib) Efficacy in Lung Cancer

Alunbrig (brigatinib) is an anaplastic lymphoma kinase (ALK) inhibitor approved for the treatment of patients with ALK-positive metastatic non-small cell lung cancer (NSCLC) who have progressed on or are intolerant to crizotinib. Clinical trials have demonstrated that brigatinib has significant efficacy in this patient population. In the pivotal phase 2 trial known as ALTA, patients treated with brigatinib after crizotinib failure showed an objective response rate (ORR) of 45-56%, depending on the dosage received. Moreover, the median progression-free survival (PFS) was reported to be between 13.8 and 16.7 months, highlighting the drug's potential in controlling disease progression.

Further supporting its efficacy, brigatinib has shown activity against central nervous system (CNS) metastases, a common complication in ALK-positive NSCLC. In the ALTA trial, intracranial response rates were encouraging, with a significant proportion of patients experiencing a reduction in CNS lesions. This ability to penetrate the blood-brain barrier and exert anti-tumor effects within the CNS is a notable advantage in the management of lung cancer with brain metastases.

Lorviqua (lorlatinib) Efficacy in Lung Cancer

Lorviqua (lorlatinib) is another ALK inhibitor used in the treatment of ALK-positive metastatic NSCLC. It is designed to inhibit the most common ALK mutations, including those resistant to other ALK inhibitors. Lorlatinib is particularly effective in patients who have previously been treated with one or more ALK inhibitors. In a phase 2 trial, lorlatinib demonstrated an ORR of 47% in patients who had received at least one prior ALK inhibitor. The median PFS was impressive, with patients experiencing a median duration of 7.0 months before disease progression.

Similar to brigatinib, lorlatinib has also shown a strong capability to manage CNS metastases in ALK-positive NSCLC patients. In clinical studies, lorlatinib achieved substantial intracranial responses, indicating its effectiveness in treating and controlling brain metastases. This characteristic is particularly valuable, as CNS involvement is a challenging aspect of lung cancer treatment and is associated with a poorer prognosis. Lorlatinib's ability to address this issue provides a critical option for patients with advanced-stage disease.

Regulatory Agency Approvals

Alunbrig

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA
Pharmaceuticals and Medical Devices Agency (PMDA), Japan

Lorviqua

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

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