Study aid only. Verify against current guidelines, primary literature, staging manuals, and prescribing information before clinical use.

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ALK-Rearranged NSCLC (Stage IV) — Systemic Therapy

First-line Second-line SECOND-LINE Stage IV NSCLC ALK rearrangement confirmed First-line Later-line Preferred Lorlatinib CROWN ↗ CNS Alternative Alectinib ALEX ↗ CNS Alternative Brigatinib ALTA-1L ↗ CNS If not used 1L Lorlatinib next-gen ALK TKI ↗ CNS Post-TKI Platinum / pemetrexed cytotoxic option