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Christoph Weinlinger



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    P2.14 - Targeted Therapy (ID 183)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.14-46 - Treatment Observations and Clinical Experience with Lorlatinib in Pretreated ALK and ROS1 Rearranged NSCLC Patients (ID 2524)

      10:15 - 18:15  |  Author(s): Christoph Weinlinger

      • Abstract
      • Slides

      Background

      Patients with non-small cell lung cancer (NSCLC), showing anaplastic lymphoma kinase (ALK)-or proto-oncogene 1 (ROS1)-rearrangement are routinely treated with tyrosine kinase inhibitors (TKIs). Although treatment is usually very effective resistance invariably develops over time. Lorlatinib a third generation TKI was recently approved by the FDA for patients who progressed on crizotinib and at least one other tyrosine kinase inhibitor. Here we report our experience with this novel brain-penetrant TKI.

      Method

      32 NSCLC patients, heavily pretreated with various chemotherapies and TKIs, have been treated with lorlatinib (100mg daily p.o.) as part of a pre-approval access program (PAA) between June 2016 and April 2019 at the Otto-Wagner-Hospital. We collected patient characteristics including sex, age, race and smoking history. Clinical response rates and progression free survival was assessed in all.

      Result

      21 patients were women and 11 men. The overall mean age was 57.3 years (59.2 female/53.2 male). 20 patients were never smokers (62.5%), 7 were former smokers (21.9 %), 2 were active smokers (6.3%). Smoking history was unknown in 3 patients (9.4%). Of the 32 patients 23 were ALK+ and 9 ROS1+. Lorlatinib was given in various lines of treatment from 2nd up to 6th line while one patient even received it in 11th line. All treated patients were Caucasian. Three patients showed a complete response (9.4%), 8 a partial response (25%), 5 are still showing stable disease (15.6%). Disease progression was noted in 16 patients (50%). The mean PFS (progression free survival) was 8.5 months, whilst treatment of 15 patients is still ongoing. ALK+ patients (n=23) showed a mean PFS of 7.9 months and ROS1+ patients (n=9) a mean PFS 9.8 months. Patients receiving brigatinib before switching to lorlatinib reached a mean PFS of 9.4 months (n=13; 12 ALK+/1 ROS1+) while patients who received lorlatinib after alectinib experienced a mean PFS of 4.93 months (n=8 ALK+). After crizotinib we found a mean PFS of 9 months (n=5; 5 ROS1+) and after ceritinib a mean of 10 months (n=6; 3 ALK+/3 ROS1+). The treatment was generally well tolerated.

      Conclusion

      Lorlatinib was overall well tolerated and it was highly effective in these pretreated ALK and ROS1 rearranged NSCLC patients.

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