# eXalt3

Source: https://onco.cc/trials/nct02767804/  
OnCo record `nct02767804` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

eXalt3 showed that ensartinib, a second-generation ALK pill, kept ALK-positive lung cancer under control about twice as long as crizotinib, with useful activity against brain metastases.

## Summary

eXalt3 was an open-label, randomised phase 3 trial at 120 centres in 21 countries that compared ensartinib with crizotinib in 290 patients with advanced, recurrent or metastatic ALK-positive non-small-cell lung cancer who had not received an ALK inhibitor. Patients were randomised 1:1 to ensartinib 225 mg once daily (143) or crizotinib 250 mg twice daily (147). The primary endpoint was progression-free survival by blinded independent review, assessed in the intent-to-treat population and in a prespecified modified population with central-laboratory-confirmed ALK-positive disease.

In the intent-to-treat population, median progression-free survival was 25.8 months with ensartinib against 12.7 months with crizotinib (hazard ratio 0.51, 95% CI 0.35 to 0.72); in the modified population it was not reached against 12.7 months (hazard ratio 0.45). Among patients with target brain metastases at baseline, the intracranial response rate was 63.6 percent (7 of 11) against 21.1 percent (4 of 19) (JAMA Oncology 2021). The US label reports the same medians with a hazard ratio of 0.56 (95% CI 0.40 to 0.79) from its own analysis, response rates of 74 percent against 67 percent, median duration of response not estimable against 27.3 months among 106 and 98 responders, and a final overall survival of 63.2 against 55.7 months (hazard ratio 0.88, 95% CI 0.63 to 1.23) that was not statistically significant.

The trial supported the December 2024 US first-line approval of ensartinib (Ensacove). It compared ensartinib with crizotinib, not with alectinib or lorlatinib; ALEX, ALTA-1L and CROWN set the first-line benchmarks for the other next-generation inhibitors. The registry still lists the study as active and no longer recruiting for long-term follow-up.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-24
- Also known as: X396-CLI-301; eXALT3; eXalt3: Study Comparing X-396 (Ensartinib) to Crizotinib in ALK Positive Non-Small Cell Lung Cancer (NSCLC) Patients
- Registry id: NCT02767804
- Phase: 3
- Setting: Advanced ALK-positive non-small-cell lung cancer with no prior ALK inhibitor: ensartinib versus crizotinib
- Sponsor: Xcovery Holdings, Inc.
- Enrolled: 290
- Result: Median progression-free survival 25.8 vs 12.7 months (hazard ratio 0.51, blinded independent review, intent-to-treat); intracranial response 63.6% vs 21.1% in patients with target brain metastases.
- Outcomes: Progression-free survival (blinded independent review, intent-to-treat): Ensartinib 25.8 months vs Crizotinib 12.7 months, HR 0.51; Intracranial response rate (blinded independent review, target brain metastases at baseline): Ensartinib 63.6% vs Crizotinib 21.1%; Objective response rate (blinded independent central review, US label): Ensartinib 74% vs Crizotinib 67%
- Replication: No other trial compared ensartinib with crizotinib first line; ALEX, ALTA-1L and CROWN compared other next-generation ALK inhibitors with crizotinib instead.

## Sources

- ClinicalTrials.gov NCT02767804: https://clinicaltrials.gov/study/NCT02767804
- JAMA Oncology 2021: https://doi.org/10.1001/jamaoncol.2021.3523
- Ensacove label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1e1b2f79-678a-472a-b924-66909c8a4b2e

## Connected records

- trials: [ALEX](https://onco.cc/trials/alex/), [ALTA-1L](https://onco.cc/trials/alta-1l/), [CROWN](https://onco.cc/trials/crown/)
- cancers: [ALK-positive non-small-cell lung cancer](https://onco.cc/cancers/alk-positive-nsclc/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- technologies: [Small-molecule kinase inhibitors](https://onco.cc/technologies/kinase-inhibitors/)
- targets: [ALK](https://onco.cc/targets/alk/)
- drugs: [Crizotinib](https://onco.cc/drugs/crizotinib/), [Ensartinib](https://onco.cc/drugs/ensartinib/)
- companies: [Xcovery](https://onco.cc/companies/xcovery/)
- terms: [Brain metastases (intracranial disease)](https://onco.cc/terms/brain-metastases/), [Tyrosine kinase inhibitor (TKI)](https://onco.cc/terms/tki-term/)
- people: [Heather A. Wakelee](https://onco.cc/people/heather-wakelee/), [Martin Reck](https://onco.cc/people/martin-reck/), [Tony S. K. Mok](https://onco.cc/people/tony-mok/)
- key papers: [Ensartinib vs Crizotinib for Patients With Anaplastic Lymphoma Kinase-Positive Non-Small Cell Lung Cancer: A Randomized Clinical Trial](https://onco.cc/key-papers/paper-nct02767804-jama-oncol-2021/)

---
JSON: https://onco.cc/api/v1/entities/nct02767804.json