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  P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall

  • 26852

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    P2.01-53 - Local Treatment for Oligoprogression/Oligometastases After Failure to Crizotinib for ALK-Rearranged Stage IV Lung Cancer (ID 12044)

    16:45 - 18:00  |  Author(s): K.C Cheung
    • Abstract
    • Slides

    Background
    

    Crizotinib is approved as 1^st line treatment for ALK-rearranged stage IV non-small-cell lung cancer (NSCLC). We investigated if local treatment for oligoprogression/metastases (<=5 lesions) while maintaining crizotinib could prolong progression-free survival (PFS) for ALK-rearranged stage IV NSCLC.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    This is a retrospective review on crizotinib for ALK-rearranged stage IV NSCLC in the real-world setting in 4 public oncology hospitals. All patients who received crizotinib outside clinical trials were reviewed. Patients who developed oligoprogression/metastases following progressive disease to crizotinib were assessed for local treatment (surgery, palliative or radical radiotherapy or combination of surgery and radiotherapy) for these sites while continuing crizotinib until further progressive disease beyond the definition of oligoprogression/metastases. The primary study endpoint is PFS after local treatment for olioprogression/metastases. Secondary endpoints are overall survival and toxicity profiles.

    4c3880bb027f159e801041b1021e88e8 Result
    

    A total of 165 patients were recruited, of which 115 (69.7%) and 50 (30.3%) received it as 1^st line treatment and at later lines respectively. Of the 161 (97.6%) patients eligible for tumour response assessment, the objective response rate was 64.5%. After a median follow up of 18.5 months (range 0.6-70.1 months), the median PFS and OS of the whole population were 10.8 and 18.5 months. There was no statistical difference in PFS and OS among those who received crizotinib as 1^st line and later lines. Twenty-nine (17.6%) patients developed oligoprogression/oligometastasis following crizotinib. Eighteen (62.1%) received local treatment (surgery – 2 , stereotactic radiosurgery/radiotherapy – 7, intensity-modulated radiation therapy/tomotherapy – 3, palliative radiotherapy – 7), of whom 3 patients received 2 courses of local treatment to different oligoprogressive/oligometastatic sites at oncologists’ discretion while continuing crizotinib until their next date of progressive disease. Median PFS was significantly longer in those who received local treatment (20.9 months [95% CI 11.8-30.1 months] vs. 11.4 months [95% CI 5.1-17.7 months]; p=0.004) than those who did not for their oligoprogression/oligometastases. Median OS was not different between those who received local treatment and those who did not for their oligoprogression/oligometastases (p=0.742). Seventy-one (43.0%) patients received other ALK inhibitors following progression to crizotinib (1 line – 50, 2 lines – 19, 3 lines – 1, and 4 lines – 1). Four (2.4%) patients are still receiving crizotinib without progression. Crizotinib was well-tolerated with only 7.9% grade 3/4 adverse events. No grade >=2 events were reported for local treatment.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Local treatment for oligoprogressive/metastatic diseases could significantly prolong PFS in the real-world setting, which procrastinates the later use of other systemic therapies.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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