Brigatinib (ALK TKI) + AI MRI radiomics predicts longer iPFS vs crizotinib in ALK+ NSCLC brain mets

Brigatinib is a next-generation ALK tyrosine kinase inhibitor (TKI) compared here with crizotinib (first-gen ALK/MET/ROS1 TKI) using AI-powered volumetric + radiomic feature extraction from standard-of-care brain MRI in ALK+ NSCLC with brain metastases (ALTA-1L; NCT02737501). In this retrospective imaging analysis of baseline + first follow-up MRI, 30 brigatinib-treated patients (429 lesions) vs 40 crizotinib-treated patients (752 lesions) had deeper intracranial tumor burden reduction (median −61.6% vs −17.7%) and higher 12-month iPFS (56.7% vs 7.5%); clinically, this aligns with the established ALTA-1L CNS advantage for brigatinib over crizotinib (e.g., BIRC-assessed intracranial PFS HR ≈0.29 in baseline brain mets subgroups). Longitudinal “delta” radiomic features (especially FLAIR-derived, aggregated across all lesions) materially improved iPFS prediction versus baseline radiomics alone (C-index 0.80 vs 0.68; AUC 0.84/0.87 for 6-/12-month iPFS vs 0.75/0.72), while an exploratory lesion-level volumetric response classifier was only moderate (AUC 0.70) and limited by class imbalance; no treatment-emergent safety data were reported in this imaging-focused abstract.