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Alastair Greystoke

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    P2.13 - Targeted Therapy (Not CME Accredited Session) (ID 962)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.13-01 - Brigatinib Use in England – Where Next? (ID 14260)

      16:45 - 18:00  |  Author(s): Alastair Greystoke

      • Abstract
      • Slides


      ALK positive NSCLC is estimated to account for 1,600 cases per year in England. Brigatinib is a next generation ALK inhibitor with proven efficacy after crizotinib but its role in 1st line is still under investigation. If licensed in Europe it may further extend survival for this rare group of patients.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We conducted a multicentre retrospective study across hospitals from the National Health System (NHS) in England on ALK positive patients who were offered treatment with the newer generations of ALK inhibitors. For this analysis, patients who received treatment with brigatinib through Compassionate use program or clinical trials between 2012 and 2018 were selected. The primary aims were time of exposure to brigatinib (as a surrogate of clinical benefit) and the objective response rate (ORR). The secondary aim was the incidence of grade 3-4 toxicity. And an exploratory aim analysed the value of ALK inhibitors treatment sequence.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 30 patients with an ALK positive lung adenocarcinoma were included with a median age of 50 years. 53% of patients were female and 77% never smoked. 90% presented at diagnosis with metastatic disease and 63% developed brain metastasis. The median follow-up time since the start of brigatinib was 9.7 months and 53% of patients were on brigatinib at the time of analysis. In 57% of cases brigatinib was only used after a 2nd line of treatment. Only 6 patients were treated in the first line setting. The overall median time of exposure was 12.1 months (95% CI, 4.7 to 19.6) with a maximum exposure of 30 months. The ORR was 50% within the 28 evaluable patients. Median overall survival was not reached. Only 1 patient had grade 3-4 toxicity with increased AST. The use of brigatinib in 1st and 2nd lines (13 patients) did not reach a median exposure time and the ORR was 69%. Brigatinib post-crizotinib (9 patients) had a higher exposure time compared with post-ceritinib (13 patients), respectively, 9.1 (95% CI, 0.5 to 25.7) and 6.6 months (95% CI, 2.6 to 10.6). However the first sequence was more often used in 1st/2nd lines (50% vs 15%).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Brigatinib is an active and very well tolerated drug. Despite being used mainly in heavily pre-treated patients, our data confirm a meaningful clinical benefit in this population. Its efficacy may be higher in earlier lines and we found no clear signal favouring a specific sequence of treatment.


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