Off-label brigatinib in ALK-positive ALCL after failure of brentuximab vedotin

ALK-positive anaplastic large-cell lymphoma (ALCL), generally occurring in children and young adults, is characterized by the presence of a translocation involving ALK on chromosome 2p23. Brentuximab vedotin (BV) is the preferred therapy both in first-line and for relapsed or refractory disease. Patients in whom BV-therapy has failed have a poor prognosis, with median overall survival 2.9 months. ALK inhibitors could be of interest in this setting. A multicenter study in France evaluated brigatinib for ALK-positive ALCL after failure of BV. Objective response was seen in 14 of 15 patients (93%) and complete response in 11 of 15 (73%). The time to a complete response ranged for 8 to 325 days. Brigatinib therapy was a bridge to alloSCT in 7 patients with response. The median follow-up was 26 months. Progression-free and overall survival rates at two years were 73% and 87%, respectively. No patients permanently discontinued brigatinib because of adverse events; the dose was reduced in three patients. The authors conclude that these findings support the use of brigatinib for ALK-positive ALCL after failure of BV.