Author of

• 25950

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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: 2
  • Moderators:
  • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall

  • 27176

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    P2.13-04 - Outcomes of ALK-Positive Non-Small-Cell Lung Cancer (NSCLC) Patients Treated with Crizotinib: A Multicenter Cohort Retrospective Study. (ID 13304)

    16:45 - 18:00  |  Author(s): Qiang Wang
    • Abstract
    • Slides

    Background
    

    Crizotinib has demonstrated promising efficacy in patients with anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) in clinical trials. However, there is lack of multicenter real-world data summary with large cohort of patients, especially in China. We conducted this multicenter and retrospective study to assess the outcomes of crizotinib in, to our knowledge, the largest cohort of patients with ALK-positive advanced NSCLC.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    We reviewed medical records of 484 unselected ALK-positive NSCLC patients treated with crizotinib at five cancer centers in China from January 2013 to November 2017. Clinical data were collected from crizotinib initiation to RECIST-defined progressive disease (PD), and post-PD systemic treatment outcomes were also analyzed.

    4c3880bb027f159e801041b1021e88e8 Result
    

    A total of 428 eligible ALK-positive NSCLC patients were enrolled. Among them, 273 (63.8%) patients received crizotinib as first-line treatment. The median progression-free survival (PFS) and overall survival (OS) from crizotinib initiation were 14.4 months (95%CI: 12.4-16.4) and 53.4 months (95% CI: 33.7-73.1) respectively. In the subgroup analysis, patients received crizotinib as first-line treatment showed a higher disease control rate (DCR) and longer median OS with statistical significance compared with second-/ further line crizotinib treatment (94.8%, not estimated vs. 89.0%, 40.5 months, respectively). For 261 patients with RECIST-defined PD, multivariate COX analysis revealed that patients who received first-line crizotinib (P=0.013), continued crizotinib beyond progressive disease (CBPD) (P=0.011) and received next-generation ALKis after crizotinib failure (P<0.001) were associated with improved survival both from crizotinib progression and from the first crizotinib dose.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    This study demonstrated the clinically meaningful benefit of crizotinib treatment in the largest cohort of Chinese ALK positive NSCLC patients. CBPD and next-generation ALK TKI treatment may provide survival improvement after RECIST-defined progression on crizotinib.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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  • 27177

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    P2.13-05 - Real-World Clinical Benefit of Continuing Crizotinib Beyond Progression Disease (CBPD) in Patients with Advanced ALK-Positive NSCLC. (ID 13353)

    16:45 - 18:00  |  Author(s): Qiang Wang
    • Abstract
    • Slides

    Background
    

    Most ALK-positive NSCLC patients treated with crizotinib would ultimately develop progressive disease (PD), and continuing crizotinib beyond initial PD (CBPD) may be potentially beneficial. We aim to evaluate the survival outcomes of patients with crizotinib resistance in real-world setting and to explore the clinical efficacy of continuing CBPD treatment.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    A total of 261 ALK-positive NSCLC patients treated with crizotinib experienced RECIST-defined PD and were included in this multi-center retrospective analysis. Clinicopathologic characteristics, progressive pattern, post-PD treatment and overall survival (OS) were compared between patients continuing CBPD and those not.

    4c3880bb027f159e801041b1021e88e8 Result
    

    140 patients who continued crizotinib after disease progression were allocated to CBPD group and others were non-CBPD group. Two-sided Chi-square test showed that patients who never smoked (P=0.047), with ECOG 0-1(P=0.001), isolated intracranial progression (P<0.001) and <median PFS of initial crizotinib (P=0.002) were more likely in the CBPD group. At the analysis, 84 patients had re-PD and the median duration of crizotinib treatment post-PD was 6.8 months (95%CI: 3.639-9.869). The median OS for the overall population from the time of PD (post-PD OS) was 15.3 months (95%CI: 11.376-19.181), and was significantly longer in CBPD patients than non-CBPDs (24.1 months vs. 8.5 months, 95% CI: 0.326-0.669, HR 0.467, P<0.001). Furthermore, next-generation ALK inhibitors (ALKis) following crizotinib failure was associated with improved post-PD OS (24.9 months vs. 10.7 months, 95% CI: 0.307-0.686, HR 0.459, P<0.001).

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Continuing CBPD treatment after crizotinib resistance favorably impact survival outcomes of advanced ALK-positive NSCLC patients in the real-world. Next-generation ALKis may provide survival improvement, but comparative studies between different subsequent treatment options after PD on crizotinib are still needed.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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