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Mohammad Jahanzeb



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    P1.01 - Advanced NSCLC (ID 158)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.01-124 - Health-Related Quality of Life (HRQoL) Data in a Phase 3 Study of First-Line Brigatinib vs Crizotinib in NSCLC (ALTA-1L) (ID 507)

      09:45 - 18:00  |  Author(s): Mohammad Jahanzeb

      • Abstract
      • Slides

      Background

      Results from ALTA-1L (NCT02737501) showed that brigatinib vs crizotinib as first-line ALK therapy significantly improves progression-free survival (PFS; HR: 0.49, 95% CI, 0.33, 0.74) in advanced ALK+ NSCLC. HRQoL was evaluated as a secondary objective.

      Method

      ALK+ NSCLC patients were randomized 1:1 to brigatinib or crizotinib as first-line ALK therapy. HRQoL was assessed with the EORTC QLQ-C30 and LC13. Change from baseline, duration of improvement, and time to worsening were analyzed in the ITT-PRO population (n=131 for both groups).

      Result

      HRQoL compliance was >90% for both groups. Brigatinib substantially improved overall HRQoL vs crizotinib, as demonstrated by the estimated mean difference on change from baseline (4.1, P<0.05; Figure 1) and duration of improvement for GHS/QoL (HR=0.16, P<0.001; Figure 2), which was also supported by improvement in several functional domains and symptoms (Figure 1). No domains significantly favored crizotinib. Similar results were also observed in patients with baseline CNS metastases.

      abstract 507_figure 1.jpg

      abstract 507 figure 2.jpg

      Conclusion

      Consistent with the prolongation of PFS seen in first-line treatment of advanced ALK+ NSCLC, brigatinib improved HRQoL and prolonged the duration of improvement in GHS/QoL, and the majority of functional and symptom domains vs crizotinib.

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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): Mohammad Jahanzeb

      • Abstract
      • Slides

      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.

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