Who this is for
If you or someone close to you has been diagnosed with ALK-positive lung cancer and you are trying to understand what this means for survival and treatment — and whether outcomes today are different from the past — this is for you.
Understanding ALK-positive lung cancer
ALK-positive lung cancer is a specific subtype of non-small cell lung cancer driven by a rearrangement in the ALK gene.
It tends to occur more often in:
• Younger patients
• People who have never smoked
The important point is this:
This is not just lung cancer —
it is a form of lung cancer that we can specifically target.
What has changed — and why it matters
The biggest change in ALK-positive lung cancer has been the development of targeted therapies.
These are tablets designed to block the exact pathway driving the cancer.
The ALEX trial compared:
• Alectinib (modern targeted therapy)
• Crizotinib (older treatment)
The results showed a clear shift in outcomes.
What the results show
• Median progression-free survival: 34.8 months vs 10.9 months
• Hazard ratio: 0.43
• Significantly better control of brain metastases
• Median overall survival: ~67.5 months vs 48.5 months
At five years:
• Approximately 60% of patients treated with alectinib were still alive
What this means in simple terms
For many patients, survival is now measured in years rather than months.
Some patients are living five years or longer, and continuing treatment.
This represents a fundamental shift in what we expect from lung cancer treatment.
Why brain control matters
ALK-positive lung cancer has a tendency to spread to the brain.
Older treatments were less effective in controlling this.
Newer drugs like alectinib:
• Penetrate the brain more effectively
• Reduce the risk of progression in the brain
• Help avoid or delay the need for radiation
This is one of the key reasons outcomes have improved.
What treatment looks like over time
Treatment is usually:
• Tablet-based
• Long-term
• Generally well tolerated
Over time, resistance can develop. This is expected.
When that happens:
• We reassess the cancer
• Identify new resistance mechanisms
• Move to next-generation ALK inhibitors
Many patients go through multiple lines of targeted therapy over several years.
Why this matters
For patients in Melbourne, and for those in Sri Lanka, Indonesia, the Philippines, and the Maldives seeking a second opinion or coordinated care, ALK-positive lung cancer is one of the clearest examples of how understanding cancer biology changes outcomes.
The key is not just access to treatment —
it is accurate testing, correct sequencing, and careful interpretation of evolving data.
Key Takeaway
• ALK-positive lung cancer is a biologically distinct disease that responds well to targeted therapy.
• Modern treatment has extended survival to 5 years or longer in many patients.
• The most important step is identifying the mutation early and selecting the right treatment strategy from the beginning.
1. Peters S, Camidge DR, Shaw AT, et al. Alectinib versus crizotinib in untreated ALK-positive non–small-cell lung cancer. N Engl J Med. 2017;377(9):829-838. doi:10.1056/NEJMoa1704795
2. Camidge DR, Peters S, Mok T, et al. Updated efficacy and safety data from the ALEX study. J Thorac Oncol. 2019;14(7):1233-1243. doi:10.1016/j.jtho.2019.03.030
3. Mok T, Peters S, Camidge DR, et al. Outcomes according to CNS metastases status in the phase III ALEX study of alectinib compared with crizotinib in patients with ALK-positive NSCLC. J Clin Oncol. 2020;38(15):1611-1620. doi:10.1200/JCO.19.02925