P2.12-26 The Impact of Anlotinib for Relapsed SCLC Patients with Brain Metastases: A Subgroup Analysis of ALTER 1202

Abstract

and multivariable survival outcomes were assessed. Result: In the cohort of 5877 patients, 2892 (49%) received chemoradiation, 1300 (22%) received surgery with radiation or chemotherapy, 639 (11%) received chemotherapy alone, 628 (11%) received surgery alone, and 418 (7%) received radiation alone. Amongst patients receiving surgery, 1277 (66%) received a lobectomy or pneumonectomy. Likelihood of receiving surgery in combination with radiation or chemotherapy was higher in later years of diagnosis (15% in 2006 vs 25% in 2014, p<0.001). Stage IA was more prevalent in the group that received surgery alone (77%) or surgery with chemotherapy or radiation (75%) compared to chemoradiation (45%), chemotherapy (49%), and radiation (63%). Median overall survival was most favorable for surgery with chemotherapy or radiation (51.8 months) followed by surgery alone (33.2 months) compared to chemotherapy + radiation (26.2 months), radiation alone (17.8 months), and chemotherapy alone (11.8 months)(p<0.001). In a multivariable Cox model (Table), surgery with chemotherapy and/or radiation was associated with decreased mortality versus chemoradiation (hazard ratio¼0.6, P<0.001). Conclusion: Utilization of surgery in localized SCLC remains low, despite its association with improved survival. Future clinical trials may be needed to establish the best therapeutic strategy for these patients.

Systemic therapy options following first-line chemoimmunotherapy in small-cell lung cancer

“…The median PFS was significantly improved with anlotinib treatment in patients with baseline brain metastases when compared to placebo, median 3.8 versus 0.8 months, HR 0.15, P=0.0005. Similarly, the median OS was improved in patients with baseline brain metastases treated with anlotinib at median OS of 6.1 versus 2.6 months, HR 0.26, P=0.0061 (23). The similar PFS and OS hazard ratios in patients with baseline brain metastases when compared to the whole study population suggest that anlotinib may not have a CNS liability.…”

Intracranial complete response to toripalimab and anlotinib in a patient with recurrent brain metastases of small cell lung cancer after failure of second-line maintenance therapy: a case report

“…In addition, angiogenesis and VEGF-VEGFR pathway play important roles in brain metastases, and the inhibition of VEGFR pathway can inhibit brain metastatic tumor growth ( 20 , 21 ). The subgroup analysis of ALTER 1202 study showed that third- or further-line anlotinib could bring significant survival benefit for patients with brain metastases at baseline compared with placebo ( 22 ). The combination of anlotinib with chemotherapy as first-line treatment for extensive-stage SCLC also showed promising clinical benefits (ORR: 80–89%; median PFS: 9.4–11.4 months) in previous phase II trials ( 23 , 24 ).…”

Safety and efficacy of ICI plus anlotinib vs. anlotinib alone as third-line treatment in extensive-stage small cell lung cancer: a retrospective study

“…There are prerequisites for a response to immunotherapy in the microenvironment of brain metastases. In addition, the efficacy of anlotinib in patients with brain metastases was proven by the ALTER 1202 trial subgroup analysis, which showed that the PFS of patients with brain metastases was prolonged by 3 months (3.8 vs. 0.8 months, HR 0.15), and OS was prolonged by 3.7 months (6.3 vs. 2.6 months, HR 0.23) (Cheng et al 2019 ). Therefore, for ES-SCLC patients with brain metastases, we recommend the use of anlotinib combined with ICIs as third-line treatment.…”