1371P - First-line alectinib vs. brigatinib in advanced metastatic NSCLC with ALK rearrangement: Real-world data

Background

Alectinib and brigatinib are second-generation anaplastic lymphoma receptor tyrosine kinases (ALKs) that are widely used as first-line therapy for treating ALK-positive advanced non-small cell lung cancer (NSCLC). Given the lack of a head-to-head comparison of these drugs as first-line therapies, this retrospective observational study aimed to compare the real-world efficacy and safety of alectinib and brigatinib.

Methods

Patients who received alectinib or brigatinib as the first-line treatment for ALK-positive advanced NSCLC were evaluated for clinical outcomes of objective response rate (ORR), intracranial ORR, time to next treatment (TTNT), progression-free survival (PFS), overall survival (OS), and safety profiles.

Results

Of 208 patients who received either alectinib or brigatinib as a first-line treatment, 176 received alectinib and 32 received brigatinib. At the data cutoff point, the median follow-up duration was 10.6 months (95% CI: 9.7–11.5) in the brigatinib group and 24.6 months (95% CI: 19.4–29.9) in the alectinib group. The ORR was 91.9% with alectinib and 92.2% for brigatinib (p-value: 0.54, 95% CI: 0.35–7.30); the intracranial ORR rates were 94.6% and 100%, respectively. The rate of progression-free survival at 12 months was comparable between the alectinib group and the brigatinib group (84.8% vs. 84.1%, p-value: 0.93), and the median TTNT, PFS, and OS were not reached in either group. Treatment-related adverse events were usually mild, and treatment discontinuation due to adverse events was rare in both groups.

Conclusions

Alectinib and brigatinib had similar clinical benefits when used as the first-line treatment of NSCLC patients with ALK rearrangement in the real world.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.