Sequential use of ceritinib in crizotinib pretreated advanced ALK rearranged NSCLC is efficacious. Availability of ceritinib in resource constrained settings is limited.Sequential use of ceritinib in crizotinib pretreated advanced ALK rearranged NSCLC is efficacious. Availability of ceritinib in resource constrained settings is limited.
Retrospective analysis of a prospective audit of all patients with advanced NSCLC (approved by Institutional Ethics Committee of Tata Memorial Hospital, registered with Clinical Trials Registry India, CTRI CTRI/2013/01/003335; all patients signed a written informed consent). All patients with ALK rearranged advanced NSCLC, who progressed on crizotinib were included. Data cutoff date was 17th July 2018. OS was calculated from the date of presentation to the hospital to date of death from any cause.
Between March 2013 and April 2018, there were 100 patients. 62% were male with a median age of 50 years (IQR 21-68). 87% were never smokers and 80% had no comorbidities. 37% had received crizotinib as first line therapy. 65% had a single site progression, most commonly brain (25.5%). Overall, 38 patients received ceritinib at some point during therapy. Ceritinib was used in second line in 58% patients, third line in 29% and in fourth line and beyond in 13%. Other therapy consisted of chemotherapy (5%), crizotinib with chemotherapy (39%), crizotinib continuation (18%), Alectinib (1%) and no therapy (9%). Median follow-up of surviving patients was 50 months (range: 1 to 62). Median PFS of the patients who received ceritinib was 5 months (95%CI, 3.4 to 6.6). Median OS of the entire cohort was 30 months (95%CI, 23.6 to 36.4). The median OS of the patients who received ceritinib was 32 months (95%CI, 26.3 to 37.7) versus 29 months (95%CI, 21-37) for other therapies, p = 0.41 by log rank test.
In our cohort of patients with crizotinib resistant advanced NSCLC, there was no significant difference in OS and PFS between those who received ceritnib and those treated with chemotherapy/other TKI. In resource limited setting, chemotherapy or other TKI may be a practical alternative.
Clinical trial identification
Legal entity responsible for the study
Tata Memorial Hospital, Parel, Mumbai.
Has not received any funding.
All authors have declared no conflicts of interest.