Comparative efficacy of first-line ceritinib and alectinib in advanced ALK+ NSCLC: A cross-study indirect comparison

Abstract

Background: The efficacy of continuing anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) beyond initial disease progression for ALK-positive patients with advanced non-small cell lung cancer (NSCLC) has not been fully understood. Methods: We retrospectively analyzed 74 ALK-positive advanced NSCLC patients who received ALK-TKIs between August 2011 and July 2017 in Kumamoto university hospital and community hospitals in Japan. Continuation of ALK-TKIs beyond progressive disease (PD) was defined as > 3 weeks of ALK-TKIs treatment after PD confirmation. Results: Among 74 patients, 32 received alectinib treatment and 42 received crizotinib as first ALK-TKI treatments. Progression free survival of patients with alectinib was significantly longer than that of crizotinib in the ALK inhibitor-naïve population (32.8 months versus 13.3 months, P ¼ 0.005). Forty-one patients among the 74 patients treated with ALK-TKIs had RECIST-defined PD. Eleven of 41 RECIST-defined PD patients continued ALK-TKI therapy. The median time to tumor progression of these 11 patients was 11.7 months. The median overall survival of patients with or without continuation of ALK-TKIs beyond initial PD was 59.7 months versus 51.2 months, respectively (P ¼ 0.35). Conclusions: Continuing ALK inhibition with crizotinib or alectinib after initial PD may provide survival benefit to patients with advanced ALK-positive NSCLC.Legal entity responsible for the study: Shinya Sakata. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Comparison of Clinical Efficacy of Alectinib Versus Crizotinib in ALK-Positive Non-Small Cell Lung Cancer: A Meta-Analysis

“…However, in single-arm trial comparative study of alectinib versus ceritinib, median OS with alectinib was prolonged 24.3 vs 15.6 with ceritinib; HR: 0.65; 95% CI: 0.48–0.88 ( 29 ). It was also confirmed by the recently published cross-study indirect comparison, which demonstrated 22% lower hazard ratio compared to ceritinib; HR: 0.78 ( 30 ).…”