Alunbrig (brigatinib) vs Xalkori (crizotinib)

Alunbrig (brigatinib) and Xalkori (crizotinib) are both targeted therapies used to treat non-small cell lung cancer (NSCLC) with specific genetic alterations, but they differ in their specificity and indications. Alunbrig is specifically designed to inhibit ALK (anaplastic lymphoma kinase) and is typically used for patients who have progressed on or are intolerant to crizotinib, offering a potential treatment option for those with acquired resistance. In contrast, Xalkori was the first ALK inhibitor approved for the treatment of ALK-positive NSCLC and is often used as a first-line therapy, but patients may develop resistance over time, at which point a drug like Alunbrig might be considered. Patients should consult with their healthcare provider to determine the most appropriate treatment based on their individual medical history, the specific characteristics of their cancer, and the safety and efficacy profile of each medication.

Difference between Alunbrig and Xalkori

Metric	Alunbrig (brigatinib)	Xalkori (crizotinib)
Generic name	Brigatinib	Crizotinib
Indications	ALK-positive metastatic non-small cell lung cancer (NSCLC)	ALK or ROS1-positive metastatic NSCLC
Mechanism of action	ALK and EGFR inhibitor	ALK, MET, and ROS1 inhibitor
Brand names	Alunbrig	Xalkori
Administrative route	Oral	Oral
Side effects	Nausea, diarrhea, fatigue, cough, headache	Visual problems, nausea, diarrhea, vomiting, edema
Contraindications	Hypersensitivity to brigatinib	Hypersensitivity to crizotinib
Drug class	Tyrosine kinase inhibitor	Tyrosine kinase inhibitor
Manufacturer	Takeda Pharmaceutical Company	Pfizer Inc.

Efficacy

Alunbrig (brigatinib) Efficacy in Lung Cancer

Alunbrig (brigatinib) is a targeted therapy approved by the U.S. Food and Drug Administration (FDA) for the treatment of non-small cell lung cancer (NSCLC) with a specific genetic mutation. This medication is designed to inhibit anaplastic lymphoma kinase (ALK), which can drive the growth of cancer cells in individuals with ALK-positive NSCLC. Clinical trials have demonstrated that brigatinib is effective in treating patients with ALK-positive metastatic NSCLC who have progressed on or are intolerant to crizotinib. In these studies, brigatinib has shown a high objective response rate, meaning that a significant proportion of patients experienced a reduction in their tumor size.

In the pivotal phase 2 trial known as ALTA, patients treated with brigatinib after crizotinib failure showed a confirmed objective response rate of 53% with the 90 mg once-daily regimen and 67% with the 180 mg once-daily regimen following a 7-day lead-in at 90 mg. Moreover, brigatinib has also demonstrated a durable response, with a median progression-free survival (PFS) of 16.7 months for the 180 mg regimen. These results suggest that brigatinib is a highly effective second-line treatment for patients with ALK-positive NSCLC.

Xalkori (crizotinib) Efficacy in Lung Cancer

Xalkori (crizotinib) is another ALK inhibitor that has been a cornerstone in the treatment of ALK-positive NSCLC. Crizotinib was the first ALK inhibitor approved by the FDA for this indication and has shown significant efficacy in shrinking tumors in patients with this type of lung cancer. In clinical trials, crizotinib has been associated with high response rates in patients with advanced ALK-positive NSCLC, with an objective response rate of approximately 65-74%. Additionally, crizotinib has been shown to improve PFS when compared to standard chemotherapy regimens.

Despite the effectiveness of crizotinib, resistance to the drug often develops, leading to disease progression. In such cases, second-generation ALK inhibitors like brigatinib are considered for subsequent treatment. The PROFILE 1014 trial, which compared crizotinib to chemotherapy in previously untreated advanced ALK-positive NSCLC, showed a median PFS of 10.9 months for patients treated with crizotinib. This data underscores the role of crizotinib as a first-line treatment option, providing a significant improvement over chemotherapy for patients with ALK-positive NSCLC.

Regulatory Agency Approvals

Alunbrig

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

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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