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Meng-Ru Cheng
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P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.16-44 - Real-World Treatment Patterns and Outcomes in ALK+ NSCLC Patients Receiving Immuno-Oncology Therapy in the United States (ID 1826)
10:15 - 18:15 | Author(s): Meng-Ru Cheng
- Abstract
Background
Cancer immunotherapies are new treatment options in advanced non-small cell lung cancer (NSCLC). Evidence of immuno-oncology (IO) therapy efficacy in tumors with activating mutations, such as anaplastic lymphoma kinase (ALK) rearrangements, is lacking. This retrospective study describes the characteristics of ALK+ NSCLC patients treated with IO therapy and assesses treatment outcomes in these patients (time to treatment discontinuation, real-world progression-free survival [rwPFS]).
Method
The Flatiron Health Electronic Health Record (EHR)−derived database (Jan 2011−Jun 2018) was used to identify patients with advanced ALK+ NSCLC who had received IO therapies (nivolumab, pembrolizumab, atezolizumab, durvalumab). Discontinuation of IO therapy was defined as switch to an ALK TKI or chemotherapy or addition of chemotherapy (for IO monotherapy), death, gap between IO administrations >120 days, or gap between last IO therapy administration and last follow-up date of >120 days. rwPFS was estimated as the time from treatment initiation to progression (abstracted from clinician notes and radiology reports) or death. Time to discontinuation and rwPFS were analyzed using Kaplan-Meier methods.
Result
Of 593 ALK+ NSCLC patients with follow-up between 2015−2018, 83 (14%) patients were treated with IO therapy. Mean age was 60.3 years, with 65.1% of patients diagnosed at stage IV, and 61.4% patients receiving nivolumab. Of the 83 IO-treated patients, 50.6% received IO therapy before first ALK TKI, and 38.6% were treated with IO therapy after ≥2 ALK TKIs. Median (95% CI) time to discontinuation of IO therapy was 2.17 mo (1.41−3.32) and rwPFS was 2.34 mo (1.55−3.09).
Conclusion
We identified ALK+ NSCLC patients who received IO therapy, half of whom were treated post-ALK TKI. Time to discontinuation of IO therapy was short, and real-world effectiveness (rwPFS) was limited. These results point to IO therapy’s relative futility in ALK+ NSCLC patients. Compared to IO therapy, several approved ALK inhibitors have shown better effectiveness in both first and later lines of therapy. However, the optimal sequencing of ALK inhibitors with other therapies, including chemotherapy and IO therapy, remains unclear.
