In patients who have pneumonitis related to ALK inhibitor therapy, is it possible to rechallenge patients with the same drug or a different ALK inhibitor?

Lung toxicity in patients treated with ALK TKIs is a rare event, occurring in about 1-2% of patients, but can be serious and life threatening. Ceritinib may be associated with slightly less pulmonary adverse events (around 1%), while crizotinib, alectinib and lorlatinib are associated with pulmonary adverse events in about 2% of patients. Brigatinib by far has the highest rates of pulmonary adverse events occurring in up to 9% of patients, with a very distinct onset of symptoms within 24-48 and usually within 7 days from the initiation of treatment. It is for this reason that dosing of brigatinib usually starts at 90 mg/d, then escalates to 180 mg/d if tolerated after 7 days of treatment.

In patients who have mild symptoms, treatment interr...