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Poster display session

5476 - Treatment beyond disease progression: ALK inhibitors in ALK-rearranged advanced NSCLC

Date

09 Sep 2017

Session

Poster display session

Topics

Cytotoxic Therapy;  Cancers in Adolescents and Young Adults (AYA);  Targeted Therapy;  Non-Small Cell Lung Cancer

Presenters

Natasha Leighl

Citation

Annals of Oncology (2017) 28 (suppl_5): v460-v496. 10.1093/annonc/mdx380

Authors

N.B. Leighl1, J. Kuo1, A. Pavel1, M. Prescilla1, F.A. Shepherd2, G. Liu3, P. Bradbury4, M. Moskovits1

Author affiliations

  • 1 Department Of Medical Oncology And Hematology, Princess Margaret Cancer Centre, University of Toronto, M5G2M9 - Toronto/CA
  • 2 Department Of Medical Oncology And Hematology, Princess Margaret Cancer Centre, M5G 2M9 - Toronto/CA
  • 3 Department Of Medical Oncology And Hematology, Princess Margaret Hospital, M5G 2M9 - Toronto/CA
  • 4 Medical Oncology, Princess Margaret Cancer Centre, Toronto/CA
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Resources

Abstract 5476

Background

Treatment of patients with ALK-EML4 gene rearrangement with ALK inhibitors (ALK-I) yields high response rate (RR) and prolonged progression free survival (PFS). Defining progressive disease (PD) using RECIST has been challenging in the era of targeted and immunotherapy, as some patients are perceived to be deriving ongoing benefit despite PD by RECIST. We explore the impact of treatment beyond progression with ALK-I on patient symptoms and treatment duration.

Methods

Patients with advanced ALK-rearranged lung cancer treated at the Princess Margaret Cancer Centre between 2009 and 2017 were identified. Treatment duration was obtained from medical records, assessment of PFS by RECIST 1.1 from patient imaging, and patient self-reported symptoms and performance status (Edmonton Symptom Assessment Scale (ESAS), ECOG PS) were collected prospectively.

Results

66 patients were identified with advanced ALK-rearranged lung cancer. The median age at diagnosis was 61 years, 49% were male, 78% presented with stage 4 disease, 47 received ALK-I therapy (median 2 lines, range 1-4). Over half (26/47, 55%) continued ALK-I treatment beyond RECIST PD. PD occurred most commonly in brain (15/47), lung and/or pleura (11/47); 17/47 received local therapy (predominantly radiation) and continued ALK-I. Data on time to RECIST PD and treatment failure are shown below. Only 34/47 patients had symptom data available at baseline, 22 with severe symptoms; 70% improved with initial ALK-I treatment. At the time of RECIST PD, most of those continuing ALK-I beyond progression had not experienced deterioration of symptoms.Table:

1347P ALK-I Treatment Patterns

Initial ALK-I (N = 47)Second ALK-I (N = 26)
Median Time to RECIST PD10.1 months (range 0.3-– NR)4.8 months (range 0.5 – NR)
Pts continuing ALK-I beyond PD17/47 (36%)8/26 (30%)
Median duration of treatment beyond progression5.0 (range 0.6 – NR)3.9 (range 1.3-21.5)

NR- not reached.

Conclusions

Treatment beyond disease progression for patients with advanced lung cancer harboring ALK rearrangement is common and is often associated with maintenance of symptom burden.

Clinical trial identification

Legal entity responsible for the study

UHN, University of Toronto

Funding

None

Disclosure

All authors have declared no conflicts of interest.

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