Comparison and selection of brigatinib/brigatinib (Embry) and crizotinib

Brigatinib/Brigatinib (Brigatinib) and crizotinib (Crizotinib) are both important targeted drugs for ALK-positivenon-small cell lung cancer, but there are obvious differences between them in terms of drug mechanism, depth of action, central system coverage, and ability to control after drug resistance. For patients who have just been diagnosed with ALK-positive lung cancer, discussing "which one is more appropriate" with their doctor is a step that almost everyone will go through. Understanding the differences between the two drugs is the key to long-term treatment planning.

Crizotinib, as an early clinically applied ALK inhibitor ALK inhibitor, has long accumulated a large amount of experience in use around the world. It is characterized by a relatively smooth onset of action and the ability to quickly inhibit tumor proliferation signals, allowing patients to achieve significant improvement in symptoms in the early stages. However, with the development of precision medicine, the limitations of crizotinib have gradually emerged, the most prominent of which is its limited ability to control the central nervous system. This means that some patients may develop brain metastasis during treatment, especially those with existing central nervous system involvement, who are more dependent on drug selection.

The emergence of brigatinib is precisely to make up for these shortcomings. As a subsequently developed ALK inhibitor, it has wider target coverage, stronger ability to fight drug-resistant mutations, and is easier to enter the central nervous system, making brain control one of its important advantages. In clinical application, brigatinib is believed to be able to prolong the time of disease stabilization and maintain the patient's condition within a safer range, which has been frequently mentioned in real-world studies.

However, the choice between brigatinib and crizotinib should not only focus on the focus of the drug, but also consider the patient's basic condition. From the perspective of treatment rhythm, crizotinib is usually well tolerated in the early stage of treatment, and some patients have few skin reactions and mild gastrointestinal discomfort. Therefore, crizotinib may be more acceptable in the early stage for patients who have just started treatment, are weak, or have many complications. Although brigatinib is more effective, it is more likely to cause dose-related lung discomfort in the early stages. Therefore, doctors often adopt a phased dose increase strategy to allow patients to gradually adapt.

From the perspective of long-term control, brigatinib is generally considered to have more durable anti-tumor ability. Especially when the disease has already developed central metastasis or has a higher risk of progression, the selection advantage of brigatinib will be more obvious. It can inhibit more types of ALK mutations, which means that even if the tumor undergoes structural changes during treatment, brigatinib may still maintain the inhibitory effect, which is critical to prolonging the stable period of the disease.

In addition, drug selection also needs to consider the path to drug resistance. If patients take crizotinib as the initial treatment, once resistance develops, they will often switch to second- or third-generation ALK inhibitors. Patients who use brigatinib as the initial treatment require more sophisticated genetic analysis after resistance to determine whether there are clear resistance mutations that can be subsequently targeted. In other words, brigatinib, as first-line use, is more suitable for patients who want to gain stronger control in the early stages and have a longer treatment plan.

Reference materials:https://www.alunbrig.com/