Real-world patients with advanced ALK-positive non-small cell lung cancer (NSCLC) — especially those with brain metastases — have poor outcomes with ALK tyrosine kinase inhibitor (TKI) therapy, found a retrospective analysis published in The Oncologist.
Using the Flatiron Health database, 581 patients were identified as receiving ALK TKI therapy between January 1, 2011, and June 30, 2018, in the first-line setting, and 254 patients received these medications in the second-line setting.
The most common first-line agent was crizotinib (84.6%) followed by alectinib (13.7%) and ceritinib (1.5%). Patients who received crizotinib in the first-line setting typically went on to receive ceritinib (49.6%) or alectinib (41.7%) in the second-line setting; less frequently those patients received crizotinib again (5.9%) or brigatinib (2.8%).
Patients treated with ALK TKI therapy in the first-line setting lived a median of 7.47 months without disease progression (95% CI, 6.48–8.32 months). Patients treated with crizotinib upfront had a median progression-free survival (PFS) of 6.64 months (95% CI, 5.99–7.80 months), which the study authors described as “similar” to the results of other real-world studies but “shorter” than the PFS reported for crizotinib in clinical trials.
The median overall survival (OS) among real-world patients treated in the first-line setting was 25.79 months (95% CI, 21.15–31.41 months), which “differed” from the “not reached” OS observed with crizotinib in the PROFILE 1014 (ClinicalTrials.gov Identifier: NCT01154140) trial.
Patients who had brain metastases on or before starting first-line therapy had particularly poor outcomes, living a median of 4.97 months without disease progression. In contrast, patients without brain metastases on or before starting first-line therapy lived a median of 8.52 months, a difference that was statistically significant (P <.0001). Patients without brain metastases on or before starting first-line therapy also lived longer than patients with brain metastases (31.41 vs 15.46 months, respectively; P =.0002).
Jahanzeb M, Lin HM, Pan X, et al. Real‐world treatment patterns and progression‐free survival associated with anaplastic lymphoma kinase (ALK ) tyrosine kinase inhibitor therapies for ALK+ non‐small cell lung cancer [published online June 3, 2020]. Oncologist. doi: 10.1634/theoncologist.2020-0011