What is the difference between Brigatinib and Lorlatinib? Which one works better?

Brigatinib/Brigatinib(Brigatinib) and lorlatinib (Lorlatinib) are oral anti-tumor drugs that are targeted therapiesALK(anaplastic lymphoma kinase) fusion-positive non-small cell lung cancer (NSCLC) drugs. Although both are inhibitors of ALK, they have some differences in drug characteristics, clinical efficacy and resistance mechanisms. The following is a detailed comparison of Brigatinib/Brigatinib and Lorlatinib:

1.Drug characteristics:

Brigatinib/Brigatinib：Brigatinib/Brigatinib is a multi-target tyrosine kinase inhibitor (TKI), not only inhibits ALK kinase activity, but also inhibits kinases such as ROS1, FLT3 and VEGFR. It has strong anti-tumor activity, can penetrate the blood-brain barrier, and also has an inhibitory effect on brain metastases.

Lorlatinib: Lorlatinib is also a multi-target tyrosine kinase inhibitor (TKI), which not only inhibitsALK kinase activity, but also inhibitsALKkinase activity. span>ROS1, EGFR and INSR and other kinases. It has high brain-blood barrier permeability and can effectively control brain metastasis in NSCLC patients.

2.Clinical efficacy:

Brigatinib/Brigatinib：Brigatinib/Brigatinibhas shown good efficacy in both first-line and second-line treatments. Results from clinical trials (ALTA-1L and ALTA) show that brigatinib/< span>Brigatinibcan significantly prolong the progression-free survival (PFS) and overall survival (OS) of patients, and reduce the risk of tumor progression. In addition, Brigatinib/Brigatinib also shows certain activity against ALK resistance mutations.

Lorlatinib: Lorlatinib has also shown significant efficacy in first-line and second-line treatment. Results from clinical trials (NCT01970865 and NCT02484491) show that lorlatinib can prolong progression-free survival and overall survival in patients, including those who have received other ALK inhibitors and developed resistance.

3.Resistance mechanism:

Brigatinib/Brigatinib: For some common ALK resistance mutations, such as ALK Mutations such as G1202R and L1196M have relatively low inhibitory effects. However, for some ALK resistance mutations, such as the T790M mutation of ALK, brigatinib still shows certain anti-tumor effects.

Lorlatinib: Lorlatinib versusALKIt shows strong inhibitory activity in terms of drug-resistant mutations. It can act on a variety of ALK resistance mutations, including common mutations such as G1202R, L1198F and G1269A, etc., as well as rare mutations such as I1171N and S1206Y etc.

4.Safety and Tolerability:

Brigatinib/Brigatinib: Brigatinib/Common adverse events of Brigatinib include nausea, vomiting, diarrhea, fatigue, hypertension and pneumonia. It may also lead to prolonged electrocardiogram QT interval and abnormal liver function. Regular monitoring of electrocardiogram and liver function is routine during treatment.

Larlatinib: Common adverse events of lorlatinib include diarrhea, fatigue, weight gain, hypertension, and abnormal taste. It may also cause pneumonia, prolongation of the electrocardiogramQT interval, abnormal liver function and abnormal renal function. Likewise, regular monitoring of electrocardiogram, liver function, and kidney function is necessary.

The specific answer to the question of which drug is better depends on the individual patient's circumstances, mechanisms of resistance, and physician recommendations. There is currently no clear evidence that one drug performs better in all patients. The choice of treatment regimen should be determined based on patient characteristics, analysis of resistance mechanisms, and recommendations from clinical guidelines.

During the decision-making process, it is recommended that patients conduct full discussions and evaluations with their doctors, and comprehensively consider the drug's efficacy, resistance mechanism, side effects and individual patient characteristics to formulate an individualized treatment plan that is most suitable for the patient. Close patient monitoring and collaboration with physicians is important to adjust treatment and address potential problems.

Brigatinib/Brigatinib has been launched in China and has been included in medical insurance. Since it has just been approved for marketing, patients may not be able to buy it in domestic pharmacies. If you need to purchase it in China, please consult the local pharmacy. However, the price is quite high, more than 10,000 yuan. Foreign Brigatinib/Brigatinib is mainly a generic drug, mainly from Bangladesh and Laos. The price of the international version of the Bangladeshi generic drug Yaopin is about 2000 yuan, and the specification is 90mg*30Tablets; the price of the Laos version of generic drugs is about 600, and the specifications are smaller. And the ingredients of domestic original drugs and foreign generic drugs are basically the same.

The price of purchasing lorlatinib in China is about25,000 yuan. Please consult your local pharmacy for details. Because the price is very high, ordinary families simply cannot afford it. Therefore, it is a wise choice for some Chinese patients with ALK-positive lung cancer to purchase overseas lorlatinib. In addition to domestic original drugs, there are also foreign original drugs and generic drugs. Foreign original drugs are mainly Turkish versions of original drugs, and the price is about 13,000~14,000 yuan; secondly, there are cheaper foreign generic drugs. Pharmaceuticals, such as Bangladeshi generic drugs, Laos generic drugs, etc., due to different specifications and manufacturers, the price ranges from 1300~4000yuan, and the drug ingredients are the same as the original drugs.