Overall Survival of Patients With ALK-Positive Metastatic Non–Small-Cell Lung Cancer in the Russian Federation: Nationwide Cohort Study

Abstract

PURPOSE The overall survival (OS) results in patients with ALK-positive metastatic non–small-cell lung cancer (NSCLC) have rarely been reported. The aim of this prospective-retrospective cohort study was to obtain real-world data on the use of crizotinib or chemotherapy in patients with ALK-positive metastatic NSCLC in Russia. PATIENTS AND METHODS Patients with epidermal growth factor receptor–negative metastatic NSCLC were screened in 23 cancer centers. To be eligible, patients were required to have confirmation of ALK rearrangement. Patients were treated with crizotinib (250 mg twice daily; n = 96) or the investigator’s choice of platinum-based chemotherapy (n = 53). The primary end point was OS. RESULTS A total of 149 ALK-positive patients were included. Mean age was 53 years in both groups. Patients were predominately women (59%) and never-smokers (74%), and most patients had adenocarcinoma histology (95%). At a median follow-up time of 15 months, 79 of the 149 patients included in the analysis had died. Median OS from the start of treatment was 31 months (95% CI, 28.5 to 33.5 months) in the crizotinib group and 15.0 months (95% CI, 9.0 to 21.0 months) in the chemotherapy group ( P < .001). The objective response rate was 34% in the crizotinib group. Among patients with brain metastasis, one complete response (6%) and five partial responses (31%) were achieved. Grade 3 adverse events were observed in three patients (3%) in the crizotinib group. CONCLUSION The improved OS observed in crizotinib clinical trials in ALK-positive NSCLC was also observed in the less selective patient populations treated in daily practice in Russia. The use of standard chemotherapy in these patients remains common but seems inappropriate as a result of the effectiveness of newer treatments, such as crizotinib.

Transcriptomics-Guided Personalized Prescription of Targeted Therapeutics for Metastatic ALK-Positive Lung Cancer Case Following Recurrence on ALK Inhibitors

“…For male ALK mutation-positive patients treated with one or more lines of ALK inhibitors the median overall survival after stage IV diagnosis was found to be 48 months (30), while in the case of our patient the overall survival was 70 months. The patient's survival since the start of therapy with crizotinib (line 3) was 36 months which exceeds previously reported median values of 31 (6) and 16.6 months (31). Moreover, the median overall survival after progression on crizotinib was reported to be 25 months on next-generation ALK-inhibitors and only 6.4 months on the other therapies (31).…”

“…The current standards of care for patients with advanced ALK -mutated NSCLC include therapy with targeted ALK-specific therapeutic crizotinib and other selective ALK inhibitors (5). The median overall survival from the onset of treatment with crizotinib can reach 31 months (6). Although response rate on selective ALK inhibitors is high, there is a major problem of acquiring resistance to these therapeutics within 1–2 years from the onset of therapy (5).…”

Agreement between PDL1 immunohistochemistry assays and polymerase chain reaction in non-small cell lung cancer: CLOVER comparison study

“…In contrast, more significant differences in PDL1 expression were found in IC. Regarding ALK translocation, which is determined in 8% of Russian patients 18 , the numbers in each category are rather small for interpretation. However, patients with ALK-positive lung cancer were more likely to express PDL1 in TC than patients without ALK rearrangements.…”

Anaplastic Lymphoma Kinase-Positive Primary Lung Adenocarcinoma Presenting With Pericardial Effusion and Tamponade in a COVID-19 Patient: A Case Report

“…Despite treatment, overall five-year survival for all stages of adenocarcinoma is 15% [10]. The overall survival in metastatic ALK-positive adenocarcinoma is also very poor [18].…”