Brigatinib

How it works

It inhibits ALK and several resistance-associated ALK mutations, blocking the downstream signalling that drives proliferation and survival of ALK-rearranged tumour cells.

Prescribing in practice

• Early-onset pulmonary adverse events, including interstitial lung disease or pneumonitis, can occur soon after starting and require prompt assessment, dose interruption and stopping if confirmed.
• It is a specialist oncology agent used only in confirmed ALK-positive disease.
• Hypertension, bradycardia, raised pancreatic enzymes, hyperglycaemia and visual disturbance may occur; exposure is affected by strong CYP3A inhibitors and inducers.

Monitoring

Monitor for respiratory symptoms early in treatment, alongside blood pressure, heart rate, blood glucose, pancreatic enzymes and visual changes.

Counselling the patient

• Report new or worsening breathlessness, cough or chest tightness urgently, especially in the first week.
• Avoid grapefruit and check new medicines for interactions.
• Effective contraception is advised during and for a period after treatment.

Evidence & guidelines

Its efficacy in ALK-positive non-small cell lung cancer is supported by the ALTA-1L trial and reflected in NICE guidance.