Induction with alectinib or crizotinib is feasible in patients with ALK–positive, stage III non-small cell lung cancer (NSCLC), according to a study presented at the American Association for Thoracic Surgery (AATS) Annual Meeting.
The study also showed better long-term outcomes among patients who received alectinib than among those who received crizotinib.
The single-center, retrospective study included 40 patients with ALK–positive, stage IIIA-B NSCLC who had received no prior targeted therapy or immunotherapy. At baseline, the patients’ mean age was 49 years, 52.5% of patients were men, and 77.5% were never smokers.
A total of 19 patients received crizotinib, and 21 received alectinib. The median treatment duration was 96 days overall, 103.5 days in the alectinib group, and 81.5 days in the crizotinib group.
In the crizotinib group, 13 patients proceeded to radical surgery, 1 received local radiation, and 5 continued on tyrosine kinase inhibitor (TKI) treatment. In the alectinib group, 17 underwent radical surgery, 3 received local radiation, and 1 continued on TKI treatment.
Among the 25 patients who had pathologically confirmed node-positive disease, the N downstaging rate was 60% overall, 71.4% in the alectinib group, and 45.5% in the crizotinib group.
The overall response rate was 71.4% in the alectinib group and 73.7% in the crizotinib group (P >.99). The major pathologic response rate was 64.7% and 46.2%, respectively (P =.46). The pathologic complete response rate was 35.3% and 15.4%, respectively (P =.41).
The median duration of surgery was 150±56.7 minutes overall, 150±65.4 minutes in the alectinib group, and 160±42.8 minutes in the crizotinib group (P =.80). The median blood loss was 37.5 mL overall, 30 mL in the alectinib group, and 60 mL in the crizotinib group (P =.03). The median length of hospital stay was 5 days, 4 days, and 5 days, respectively (P =.15).
There were no deaths at 30 days or 90 days after surgery in either group. The median overall survival was 62.6 months overall, not reached in the alectinib group, and 62.6 months in the crizotinib group (P =.183).
The median progression-free survival was 23.9 months overall, not reached in the alectinib group, and 17.9 months in the crizotinib group (P <.001). Relapse occurred in 14.3% of patients in the alectinib group and 89.5% of those in the crizotinib group.
Based on these results, the researchers concluded that induction with ALK-TKIs is clinically feasible and safe in heterogenous, stage III NSCLC, and alectinib produced better long-term outcomes than crizotinib.
Disclosures: This research was supported by Roche. No other disclosures were provided.
Zhang C, Jiang B-Y, Yan Li-Xu, et al. Induction ALK-TKIs for stage III non-small cell lung cancer harboring ALK fusion: A single-center experience with 3-year follow-up. AATS 2023. May 6-9, 2023. Abstract 48.