Abstract 1131P
Background
Tyrosine kinase inhibitors (TKIs) are the preferred first-line treatment for patients with stage IV non-small cell lung cancer with anaplastic lymphoma kinase (ALK) rearrangement. Several randomized controlled trials reported favourable results with second and third generation TKIs over treatment with first generation TKI crizotinib. We compared real-world overall survival between patients treated with alectinib versus crizotinib in a population-based series from the Netherlands.
Methods
Based on data from the Netherlands National Cancer Registry, we selected patients diagnosed between 2015 and 2019 with stage IV non-squamous NSCLC and an ALK rearrangement, treated in first line with crizotinib or alectinib. Follow-up information was available up to 01-02-2022 and three-year overall survival (OS) including 95% confidence intervals (CI) was calculated from start of TKI treatment. Survival differences between TKIs were evaluated using multivariable Cox regression analysis, controlling for age group and WHO performance status, and are reported as hazard ratios (HR) with 95% CI.
Results
The series comprised a total of 190 patients with a median age of 61 years, 52% females, 19% with brain metastasis at diagnosis. Three-year overall survival was 50% (95% CI 43-57) and outcome was considerably better for patients treated with alectinib (67%, 95% CI 55-76) than for crizotinib (37%, 95% CI 28-46). Multivariable analysis confirmed the superior results, both overall (HR 0.35, 95% CI 0.22-0.56) as for the subgroup with brain metastasis (HR 0.14, 95% CI 0.04-0.50).
Conclusions
Real-world evaluation confirms the superiority of second generation ALK-TKIs, especially in patients with brain metastasis.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
A.J. Van Der Wekken: Financial Interests, Institutional, Research Grant, Outside this work: AstraZeneca, Boehringer Ingelheim, Roche, Pfizer, Takeda; Financial Interests, Institutional, Advisory Board, Outside this work: AstraZeneca, Boehringer Ingelheim, Roche, Pfizer, Takeda, Janssen, Lilly, Merck, Novartis. All other authors have declared no conflicts of interest.