At ASCO, Ariad commented that 50% of patients that progress on Xalkori have brain mets. A recent study published by Comprehensive Cancer Center at the MedUni Vienna found that ALK translocations were found in 2.6% of NSCLC patients with brain mets. Since the ALK incidence rate is approximately 5%, my guess is that this how the 50% of ALK patients number is being derived.
The big unanswered question is whether the ALK rearrangement is present all along or whether this is a function of resistance. In the Vienna study researchers found that "changes to the ALK gene are also demonstrable in the brain metastases of lung cancers – and not just in the lung tumour itself" which seems to imply that the brain mets are present in ALK+ patients all along. If this is true, then using the drug that shows the best reponse against brain mets first, should lead to better overall outcomes for roughly half of ALK+ patients. The separate brain met cohort will hopefully tell us whether AP26113 is that drug.
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