To date, no head-to-head trials have compared the efficacy of
brigatinib and
alectinib against
anaplastic lymphoma kinase (ALK) rearrangement-positive (ALK-p), ALK-inhibitor-naïve, advanced
non-small cell lung cancer (NSCLC) with central nervous system (CNS)
metastasis. We conducted an indirect treatment comparison (ITC) between
brigatinib and
alectinib, with
crizotinib as a common comparator, using a Bayesian model with non-informative prior distribution and assessed the between-study heterogeneity of the studies. The primary efficacy endpoint was progression-free survival (PFS), and efficacy was ranked using the surface under the cumulative ranking (SUCRA) curve values. ITC analysis showed that there were no significant differences in PFS between the
brigatinib and
alectinib arms. However, the SUCRA values revealed that
alectinib ranked the highest by efficacy in the overall patient population, whereas
brigatinib ranked the highest by efficacy in the CNS
metastasis sub-group. Although there were no significant differences in the incidence of G3-5 adverse events between the
brigatinib and
alectinib arms in the overall patient population, the data were deemed insufficient for the CNS
metastasis sub-group analysis. This study provides critical information to clinicians regarding the efficacy of
brigatinib for ALK-p, ALK-inhibitor-naïve, advanced NSCLC patients, with and without CNS
metastasis. Larger randomized, controlled trials are warranted to confirm our results.