Real-World Treatment Patterns and Survival Outcome in Advanced Anaplastic Lymphoma Kinase (ALK) Rearranged Non-Small-Cell Lung Cancer Patients
Introduction: Survival of ALK-rearranged NSCLC patients has dramatically improved by the use of multiple ALK-tyrosine kinase inhibitors (ALK-TKI). However, still little is known about the impact of drug sequencing and clinical features on survival in a real-world setting.Methods: Patients with stage...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-08-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2020.01299/full |
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| author | Christian Britschgi Alfredo Addeo Markus Rechsteiner Raphaël Delaloye Martin Früh Martin Früh Giulio Metro Marco Banini Oliver Gautschi Sacha I. Rothschild Peter J. Wild Giuseppe L. Banna Alessandra Curioni-Fontecedro |
| author_facet | Christian Britschgi Alfredo Addeo Markus Rechsteiner Raphaël Delaloye Martin Früh Martin Früh Giulio Metro Marco Banini Oliver Gautschi Sacha I. Rothschild Peter J. Wild Giuseppe L. Banna Alessandra Curioni-Fontecedro |
| author_sort | Christian Britschgi |
| collection | DOAJ |
| description | Introduction: Survival of ALK-rearranged NSCLC patients has dramatically improved by the use of multiple ALK-tyrosine kinase inhibitors (ALK-TKI). However, still little is known about the impact of drug sequencing and clinical features on survival in a real-world setting.Methods: Patients with stage IV ALK-rearranged NSCLC treated at six centers in Switzerland and Italy were identified and standard clinical variables collected. OS curves were constructed using the Kaplan–Meier method and compared with the log-rank test. Multivariate Cox proportional hazard analysis was applied to determine the correlations between clinical features and OS. In four patients, biopsies were subjected to NGS.Results: One-hundred and twenty-one patients with stage IV ALK-rearranged NSCLC diagnosed between 2011 and 2016 were included. With a median follow-up time of 39.5 months, the median OS from diagnosis of stage IV disease was 48.0 months. First-line treatment consisted of an ALK-TKI in 24% of patients, with crizotinib in 83% of them. Chemotherapy as first-line treatment did not influence OS (p = 0.955). The use of more than one ALK-TKI line positively correlated with OS (p = 0.016), as well as the use of alectinib or lorlatinib in any treatment line, as compared to the use of crizotinib ± ceritinib (p = 0.022). A never smoking history was an independent prognostic factor for OS (p = 0.032). Moreover, treatment with alectinib significantly improved OS.Conclusions: Targeted treatment for ALK-positive NSCLC patients lead to prolonged OS. Smoking status was a negative independent prognostic factor in a multi-variate analysis. The use of alectinib or lorlatinib in any treatment line improved overall outcome. |
| first_indexed | 2024-12-16T15:06:49Z |
| format | Article |
| id | doaj.art-41a98d4dc44d41c88362540a74999f7d |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-16T15:06:49Z |
| publishDate | 2020-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Oncology |
| spelling | doaj.art-41a98d4dc44d41c88362540a74999f7d2022-12-21T22:27:06ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2020-08-011010.3389/fonc.2020.01299534736Real-World Treatment Patterns and Survival Outcome in Advanced Anaplastic Lymphoma Kinase (ALK) Rearranged Non-Small-Cell Lung Cancer PatientsChristian Britschgi0Alfredo Addeo1Markus Rechsteiner2Raphaël Delaloye3Martin Früh4Martin Früh5Giulio Metro6Marco Banini7Oliver Gautschi8Sacha I. Rothschild9Peter J. Wild10Giuseppe L. Banna11Alessandra Curioni-Fontecedro12Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, SwitzerlandGeneva University Hospitals (HUG), Geneva, SwitzerlandInstitute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, SwitzerlandDepartment of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, SwitzerlandDepartment of Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, SwitzerlandDepartment of Oncology, University Hospital of Bern, Bern, SwitzerlandMedical Oncology, Azienda Ospedaliera Di Perugia, Perugia, ItalyMedical Oncology, Azienda Ospedaliera Di Perugia, Perugia, ItalyUniversity of Bern and Cantonal Hospital of Lucerne, Lucerne, SwitzerlandDepartment of Internal Medicine, Medical Oncology, University Hospital Basel, Basel, SwitzerlandInstitute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, SwitzerlandPortsmouth Hospitals NHS Trust, Portsmouth, United KingdomDepartment of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, SwitzerlandIntroduction: Survival of ALK-rearranged NSCLC patients has dramatically improved by the use of multiple ALK-tyrosine kinase inhibitors (ALK-TKI). However, still little is known about the impact of drug sequencing and clinical features on survival in a real-world setting.Methods: Patients with stage IV ALK-rearranged NSCLC treated at six centers in Switzerland and Italy were identified and standard clinical variables collected. OS curves were constructed using the Kaplan–Meier method and compared with the log-rank test. Multivariate Cox proportional hazard analysis was applied to determine the correlations between clinical features and OS. In four patients, biopsies were subjected to NGS.Results: One-hundred and twenty-one patients with stage IV ALK-rearranged NSCLC diagnosed between 2011 and 2016 were included. With a median follow-up time of 39.5 months, the median OS from diagnosis of stage IV disease was 48.0 months. First-line treatment consisted of an ALK-TKI in 24% of patients, with crizotinib in 83% of them. Chemotherapy as first-line treatment did not influence OS (p = 0.955). The use of more than one ALK-TKI line positively correlated with OS (p = 0.016), as well as the use of alectinib or lorlatinib in any treatment line, as compared to the use of crizotinib ± ceritinib (p = 0.022). A never smoking history was an independent prognostic factor for OS (p = 0.032). Moreover, treatment with alectinib significantly improved OS.Conclusions: Targeted treatment for ALK-positive NSCLC patients lead to prolonged OS. Smoking status was a negative independent prognostic factor in a multi-variate analysis. The use of alectinib or lorlatinib in any treatment line improved overall outcome.https://www.frontiersin.org/article/10.3389/fonc.2020.01299/fullreal world dataNSCLCtargeted therapyoverall survivalALK-rearranged non-small cell lung cancer |
| spellingShingle | Christian Britschgi Alfredo Addeo Markus Rechsteiner Raphaël Delaloye Martin Früh Martin Früh Giulio Metro Marco Banini Oliver Gautschi Sacha I. Rothschild Peter J. Wild Giuseppe L. Banna Alessandra Curioni-Fontecedro Real-World Treatment Patterns and Survival Outcome in Advanced Anaplastic Lymphoma Kinase (ALK) Rearranged Non-Small-Cell Lung Cancer Patients Frontiers in Oncology real world data NSCLC targeted therapy overall survival ALK-rearranged non-small cell lung cancer |
| title | Real-World Treatment Patterns and Survival Outcome in Advanced Anaplastic Lymphoma Kinase (ALK) Rearranged Non-Small-Cell Lung Cancer Patients |
| title_full | Real-World Treatment Patterns and Survival Outcome in Advanced Anaplastic Lymphoma Kinase (ALK) Rearranged Non-Small-Cell Lung Cancer Patients |
| title_fullStr | Real-World Treatment Patterns and Survival Outcome in Advanced Anaplastic Lymphoma Kinase (ALK) Rearranged Non-Small-Cell Lung Cancer Patients |
| title_full_unstemmed | Real-World Treatment Patterns and Survival Outcome in Advanced Anaplastic Lymphoma Kinase (ALK) Rearranged Non-Small-Cell Lung Cancer Patients |
| title_short | Real-World Treatment Patterns and Survival Outcome in Advanced Anaplastic Lymphoma Kinase (ALK) Rearranged Non-Small-Cell Lung Cancer Patients |
| title_sort | real world treatment patterns and survival outcome in advanced anaplastic lymphoma kinase alk rearranged non small cell lung cancer patients |
| topic | real world data NSCLC targeted therapy overall survival ALK-rearranged non-small cell lung cancer |
| url | https://www.frontiersin.org/article/10.3389/fonc.2020.01299/full |
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