Start Your Search
Poster Session (ID 8)
- Event: ACLC 2018
- Type: Poster Session
- Presentations: 1
- Coordinates: 11/07/2018, 00:00 - 00:00, Poster Hall
P121 - Clinical Value of Local Therapy in Advanced Crizotinib-Treated ALK-Rearranged Lung Cancer: Pattern of Failure Analyses (ID 19)
00:00 - 00:00 | Author(s): G. Li
The pattern of failure and clinical value of local therapy (LT) in metastatic crizotinib-treated ALK-rearranged lung cancer, with or without baseline brain metastases (BBM), are largely unknown.
Consecutive patients were retrospectively enrolled and serial imaging were intensively examined. Disease progression in original sites (primary/metastatic), new sites, or both, are classified as original failure (OF), distant failure (DF) and ODF, respectively. Progression free survival, from crizotinib initiation to the first disease progression, and from that to the second disease progression, were calculated as PFS1 and PFS2.
Ninety-three patients with adequate imaging and measurable disease were identified. Fifty-seven patients received crizotinib as first-line therapy, while the remaining 36 patients had 1-2 lines of prior chemotherapy, with or without LTs. With a median follow up of 22.0 (range, 2.0-72.0) months, 52 patients had crizotinib-treatment failure, with a median PFS1 of 11.5 (95%CI 9.8-13.2) months. The frequencies of OF, ODF, and DF, were 50.0%, 26.9%, and 23.1%, respectively. Histology, primary tumor size and presence of BBM, were independently associated with OF, using competing risks analyses. The brain was the most common site of initial disease progression. Patients with BBM had a significant higher possibility developing multiple-progressive lesions in the brain (p=0.002). Brain radiation before crizotinib could alter the disease failure patterns and improve PFS1 among patients with BBM (p=0.006). Of note, four (50.0%)of the eight patients who had baseline oligo-metastatic cranial disease but did not receive prior brain radiation, developed multiple-progressive disease in the brain, while none of the four patients who had baseline oligo-metastatic cranial disease and received prior brain stereotactic radiosurgery developed multiple-progressive disease in the brain. On the other hand, extra-cranial LT before crizotinib was not associated with PFS1 (p=0.223). Thirty-five (67.3%)of the 52 patients with disease failure to crizotinib were eligible for certain kind of radiotherapy. By the time of data cut-off, 28 patients had second disease progression, with a median PFS2 of 7.0 (95% CI 5.4-8.6) months. Patients who received LT after RECIST-defined disease progression to crizotinib had a significant longer PFS2 (p=0.003). In addition, patients received any LT during their treatment course had a significant longer overall survival (p=0.048).
Among patients with BBM, brain radiotherapy before crizotinib provide considerable clinical benefits. Conversely, deferring extra-cranial local therapies until after initial crizotinib-treatment failure and adopting regular surveillance may be a better treatment strategy for metastatic lesions outside the brain.