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Ceritinib vs chemotherapy (CT) in patients (pts) with advanced anaplastic lymphoma kinase (ALK)-rearranged (ALK+) non-small cell lung cancer (NSCLC) previously treated with CT and crizotinib (CRZ): Results from the confirmatory phase 3 ASCEND-5 study

Date

09 Oct 2016

Session

NSCLC, metastatic 1

Presenters

Giorgio Scagliotti

Citation

Annals of Oncology (2016) 27 (6): 1-36. 10.1093/annonc/mdw435

Authors

G. Scagliotti1, T.M. Kim2, L. Crinò3, G. Liu4, C. Gridelli5, S. Novello1, K. Kiura6, A. Bearz7, O. Gautschi8, E. Felip9, M. Nishio10, D.R. Spigel11, T. Mok12, P. Urban13, S. Deudon13, C. Zheng14, A.T. Shaw15

Author affiliations

  • 1 Department Of Oncology, University of Torino, 10043 - Torino/IT
  • 2 Department Of Internal Medicine, Seoul National University Hospital, Seoul/KR
  • 3 Medical Oncology, University Medical School of Perugia, Perugia/IT
  • 4 Medicine, Princess Margaret Cancer Centre, Toronto/CA
  • 5 Medical Oncology, SG Moscati Hospital, Avellino/IT
  • 6 Department Of Allergy And Respiratory Medicine (thoracic Oncology), Okayama University Hospital, Okayama/JP
  • 7 Division Of Medical Oncology, IRCCS-CRO, Aviano/IT
  • 8 Department Of Medicine, Medical Oncology, Cantonal Hospital Lucerne, Lucerne/CH
  • 9 Medical Oncology, Vall d'Hebron University Hospital, Barcelona/ES
  • 10 Thoracic Medical Oncology, Cancer Institute Hospital of JFCR, Tokyo/JP
  • 11 Medical Oncology, Sarah Cannon Research Institute, Nashville/US
  • 12 Clinical Oncology, Chinese University of Hong Kong, Shatin/CN
  • 13 Clinical Research, Novartis Pharma AG, Basel/CH
  • 14 Biostatistics, Novartis Pharma, East Hanover/US
  • 15 Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston/US
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Background

The ALK inhibitor CRZ is effective in ALK+ NSCLC pts, but most develop resistance and progressive disease (PD). Ceritinib showed robust efficacy in CRZ-pretreated pts in phase 1 & 2 studies. This multicenter, open-label phase 3 study (NCT01828112) compared efficacy of ceritinib vs CT in ALK+ NSCLC pts pretreated with CT & CRZ.

Methods

ALK+ NSCLC pts pretreated with 1–2 CT regimens & CRZ were randomized to oral ceritinib 750 mg/d or CT (pemetrexed [PEM] 500 mg/m2 or docetaxel [DOC] 75 mg/m2), stratified by WHO PS (0 vs 1–2) & brain metastasis at screening. Pts discontinuing CT due to PD could crossover to ceritinib. Primary endpoint was progression-free survival (PFS), assessed by blinded independent review committee (BIRC) per RECIST v1.1.

Results

Of 231 pts (median age 54 y), 115 were randomized to ceritinib and 116 to CT (PEM, n = 40; DOC, n = 73; 3 not treated). Median treatment exposure was 30.3 wk for ceritinib and 6.3 wk for CT. Median follow-up duration was 16.5 mo. Ceritinib showed statistically significant improvement in PFS (BIRC: median 5.4 vs 1.6 mo, HR = 0.49, P < 0.001) and increased overall response rate [95% CI] (BIRC: 39.1% [30.2, 48.7] vs 6.9% [3.0, 13.1]) vs CT (Table). Of pts discontinuing CT due to PD, 75 crossed over to ceritinib. Most frequent AEs (% any grade [% grade 3/4]) were diarrhoea (72.2 [4.3]), nausea (66.1 [7.8]) & vomiting (52.2 [7.8]) with ceritinib; fatigue (28.3 [4.4]), nausea (23.0 [1.8]), alopecia (21.2 [0]) & neutropenia (20.4 [15.0]) with CT. 6 (5.2%) ceritinib- and 8 (6.9%) CT-treated pts discontinued due to AEs. Ceritinib significantly improved lung cancer-specific symptoms (LCSS & QLQ-LC13) & overall health status (EQ-5D) vs CT (P < 0.05).

Ceritinib(n = 115) CT(n = 116)
By BIRC
Median PFS, mo [95% CI] 5.4* [4.1, 6.9] 1.6 [1.4, 2.8]
ORR (CR + PR), % [95% CI] 39.1 [30.2, 48.7] 6.9 [3.0, 13.1]
DCR (CR + PR + SD), % [95% CI] 76.5 [67.7, 83.9] 36.2[27.5, 45.6]
By Investigator
Median PFS, mo [95% CI] 6.7* [4.4, 7.9] 1.6 [1.4, 2.6]
ORR (CR + PR), % [95% CI] 42.6 [33.4, 52.2] 6.0 [2.5, 12.0]
DCR (CR + PR + SD), % [95% CI] 80.0 [71.5, 86.9] 37.9 [29.1, 47.4]
Median OS, mo [95% CI] 18.1 [13.4, 23.9] 20.1[11.9, 25.1]

*Log-rank P < 0.001 vs CT

Log-rank P = 0.496 vs CT CI, confidence interval; CR, complete response; DCR, disease control rate; ORR, overall response rate; OS, overall survival; PFS, progression-free survival; PR, partial response; SD, stable disease

Conclusions

Ceritinib showed a clinically meaningful and statistically significant improvement in PFS vs CT in pretreated ALK+ NSCLC.

Clinical trial identification

NCT01828112

Legal entity responsible for the study

Novartis Pharmaceutical Corporation

Funding

Novartis Pharmaceutical Corporation

Disclosure

G. Scagliotti: Honoraria: Eli Lilly, AZ, Pfizer, Roche, Clovis Oncology Consulting/advisory, Speaker fees: Eli Lilly Travel/accommodation/expenses: Bayer. L. Crinò: Honoraria: Novartis, AstraZeneca, Boheringer Consulting/Advisory: Pfizer, Novartis AstraZeneca G. Liu: Honoraria for advisory board membership: Astra Zeneca, Novartis, Roche, Pfizer. C. Gridelli: Honoraria for advisory board membership: Novartis. S. Novello: Speaker Bureau: Eli Lilly, BMS, MSD, BI, Astra Zeneca. K. Kiura: Corporate-sponsored research: Chugai, AZ, Boehringer, Daiichi-Sankyo, and Shionogi Personal fees (including honoraria): Novartis, Chugai, Pfizer, Lilly, and Taiho. E. Felip: Consulting/Advisory: Lilly, Roche, BI, BMS, Novartis. M. Nishio: Research: Novartis/ONO Pharmaceutical/Chugai Pharmaceutical/BMS/Taiho. Pharmaceutical/Eli Lilly, Pfizer/Astellas Pharma/AstraZeneca Honoraria: Pfizer/BMS/Ono Pharmaceutical/Chugai Pharmaceutical/Eli Lilly/TAIHO pharmaceutical/AstraZeneca. D.R. Spigel: Consulting/Advisory: Novartis, Pfizer, Genentech/Roche; Speaker's bureau: Novartis; Travel/Expenses: Novartis, Pfizer, Genentech/Roche. T.S.K.Mok: Employment: CUHK Stock: Sanomics Ltd Honoraria/Research: AZ, Roche/Genentech, Pfizer, Lilley, BI, Merck Serono, MSD, Jenssen, Clovis Oncology, BioMarin, GSK, Novartis, SFJ, Acta Biosciences, Vertex, Aveo, Biodesix, BMS, GeneDecode. P. Urban, S. Deudon: Employment: Novartis Pharma AG. C. Zheng: Employment: Novartis Pharmaceuticals Corporation. A.T. Shaw: Honoraria: Novartis, Pfizer, Roche Consulting/advisory: Ariad, Daiichi-sankyo, EMD Serono, Genentech, Ignyta, Novartis, Pfizer, Roche, Taiho, Blueprint Medicine Research funding: Genentech/Roche, Pfizer, Novartis. All other authors have declared no conflicts of interest.

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