• Phase III study (N = 347) of 2^nd-line crizotinib vs pemetrexed or docetaxel in ALK-positive advanced NSCLC
• Median PFS 7.7 vs 3.0 mo, ORR 65% vs 20%, all favoring crizotinib. No difference in OS, possibly due to crossover
• Visual disturbance, nausea/vomiting, diarrhea and elevated transaminases common with crizotinib

This study is similar to many others with EGFR TKIs demonstrating that when the primary oncogenic target is present (in this case the ALK translocation), specific targeted treatment improves short-term outcomes such as PFS and response rate. Studies like these have generally not demonstrated a survival advantage, probably because of crossover to targeted treatment, but acceptance of this basic clinical paradigm is occurring rapidly, likely due to the precedent set over a number of years among patients with EGFR tumor mutations who now receive first-line TKIs as a standard approach.