Alectinib vs Crizotinib vs Lorlatinib: — Which ALK Inhibitor Is Right for You?

International guidelines from NCCN, ASCO and ESMO shifted the recommendation after clinical evidence showed alectinib delayed disease progression significantly longer and controlled brain metastases far more reliably. It also causes less nausea than crizotinib, which makes it easier to continue over a long treatment period. Crizotinib remains a valid option where access or cost makes alectinib unavailable, but it is no longer the preferred starting point where both are accessible.

Yes, and this is one of the most common treatment sequences. When crizotinib stops controlling the cancer, alectinib or lorlatinib are the options your oncologist will consider next. Retesting the tumour — through a new biopsy or a liquid biopsy — is often recommended at this point to identify which resistance mutation has developed, because that guides which drug is most likely to work. Do not switch without this assessment, as the sequence affects what remains available later.

Lorlatinib can affect memory, concentration and mood in some people. You may notice difficulty finding words, feel more forgetful than usual, or experience mood changes including anxiety or low mood. These effects are real and worth reporting to your team if they interfere with daily life, because dose adjustments are sometimes possible. They do not mean the cancer has spread to the brain — they are a direct effect of the drug crossing the blood-brain barrier. Most people continue working and managing daily tasks, though the degree varies between individuals.

Retesting is usually recommended when the first drug stops working, because the resistance mechanism can influence which next drug is most useful. A new biopsy — from the tumour or sometimes from a blood sample — can show whether a specific mutation has developed that favours one drug over another. This is not always possible in every situation, and your oncologist may make the decision based on the pattern of progression and available evidence if waiting for a result is not clinically safe.

Both have regulatory approval in India and are available through specialist oncology centres. Availability in practice depends on the centre and the supply chain at any given time. Crizotinib is the most widely available of the three. At CION, your team can confirm current availability and help coordinate access to whichever drug your oncologist recommends, including guidance on patient-assistance or affordability programmes where they apply.

This is an area where the evidence is still developing, and there is no established standard fourth-line ALK-targeted option at present. Clinical trials are actively investigating next steps, and enrolment in a trial may be worth asking about. Chemotherapy and other systemic treatments remain available regardless of prior ALK inhibitor use. Your oncologist will discuss what is appropriate based on where the cancer is, how you are feeling, and which trials are open near you.