452P - Disease progression site and subsequent therapy after progression during alectinib therapy

Date 18 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Anticancer Agents
Non-Small-Cell Lung Cancer, Metastatic
Presenter Haruyasu Murakami
Citation Annals of Oncology (2016) 27 (suppl_9): ix139-ix156. 10.1093/annonc/mdw594
Authors H. Murakami, S. Omori, K. Nakashima, K. Wakuda, A. Ono, H. Kenmotsu, T. Naito, T. Takahashi
  • Thoracic Oncology, Shizuoka Cancer Center, 411-8777 - Shizuoka/JP



Alectinib is a highly potent and selective anaplastic lymphoma kinase (ALK) inhibitor with activity against ALK-positive advanced non-small cell lung cancer (NSCLC). In a recently reported, randomized phase III trial of alectinib versus crizotinib in patients with ALK-positive advanced NSCLC, alectinib demonstrated significantly prolonged progression-free survival compared to crizotinib with a favorable safety profile. Thus alectinib has the potential to be a new standard therapy for ALK-positive advanced NSCLC. However, disease progression site and optimal subsequent therapy after progression during alectinib therapy remain unclear.


To assess the disease progression site and subsequent therapy after progression during alectinib therapy in Japanese patients, we retrospectively reviewed medical records of patients with ALK-positive advanced NSCLC who initiated alectinib therapy at the Shizuoka Cancer Center between March 2011 and December 2015.


A total of 29 patients were included in this study, and 38% (11 of 29) developed disease progression during alectinib therapy. Among these 11 patients, six (55%) had brain metastases when they initiated alectinib therapy. Disease progression sites during alectinib therapy were as follows; eight (73%) patients with extracranial lesions, two (18%) patients with intracranial lesions, and one (9%) patient with extracranial and intracranial lesions. Ten patients received subsequent therapy; seven were treated with conventional cytotoxic chemotherapy and three were treated with investigational drugs. Among six evaluable patients who were treated with conventional cytotoxic chemotherapy, the overall response rate was 50%, with three partial responses, two stable diseases and one progressive disease. All three partial responses were observed in patients who were treated with pemetrexed-containing regimens.


A majority of patients developed extracranial disease progression during alectinib therapy, and pemetrexed-containing systemic chemotherapy may be a good treatment option for those patients.

Clinical trial indentification

Legal entity responsible for the study

Shizuoka Cancer Center


Shizuoka Cancer Center


H. Murakami, S. Omori, H. Kenmotsu: Personal fees from Chugai Pharmaceutical Co., Ltd. outside of this submitted work. T. Takahashi: Grants and personal fees from Chugai Pharmaceutical Co., Ltd. All other authors have declared no conflicts of interest.