Diagnosis and Treatment of Advanced ALK Rearrangement-Positive Non-Small-Cell Lung Cancer in Portugal: Results of a National Questionnaire
Abstract Background Rearrangements in the anaplastic lymphoma kinase (ALK) gene define a molecular subgroup of non-small-cell lung carcinoma (NSCLC) that should be treated with ALK-targeting tyrosine kinase inhibitors (TKIs). Objective This study aimed to portray the Portuguese reality about the dia...
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Format: | Article |
Language: | English |
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Adis, Springer Healthcare
2023-10-01
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Series: | Drugs - Real World Outcomes |
Online Access: | https://doi.org/10.1007/s40801-023-00393-z |
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author | Ana Figueiredo Ana Rodrigues Carina Gaspar Margarida Felizardo |
author_facet | Ana Figueiredo Ana Rodrigues Carina Gaspar Margarida Felizardo |
author_sort | Ana Figueiredo |
collection | DOAJ |
description | Abstract Background Rearrangements in the anaplastic lymphoma kinase (ALK) gene define a molecular subgroup of non-small-cell lung carcinoma (NSCLC) that should be treated with ALK-targeting tyrosine kinase inhibitors (TKIs). Objective This study aimed to portray the Portuguese reality about the diagnosis and treatment of stage IV ALK-positive NSCLC. Methods Institutions that treat lung cancer in Portugal were invited to participate in an anonymous electronic questionnaire. A total of 22/35 geographically dispersed institutions responded. A descriptive statistical analysis of the results was performed. Results Reflex molecular testing was done in 54.6% of the institutions. Next-generation sequencing (NGS) was the preferred diagnostic method (90.9%). Typically, physicians obtained molecular study results within 14–21 days. Alectinib was the most commonly used first-line treatment. For patients with brain metastases, 86.4% of the physicians preferred alectinib and 13.6% preferred first-line brigatinib. In the case of asymptomatic oligoprogression in the central nervous system, 85.7% of physicians performed local treatment and kept the patient on a TKI; if symptomatic, 66.7% gave local treatment and stayed with the TKI, while 28.6% gave local treatment and altered the TKI. For patients with symptomatic systemic progression, 47.6% and 38.1% of physicians prescribed lorlatinib after initial treatment with alectinib or brigatinib, respectively. After progression on lorlatinib, 42.9% of respondents chose chemotherapy and 57.1% requested detection of resistance mutations. Conclusions NGS is widely used for the molecular characterization of ALK-positive NSCLC in Portugal. The country has access to up-to-date therapy. Overall, national clinical practice follows international recommendations for the diagnosis and treatment of ALK-positive NSCLC. |
first_indexed | 2024-03-08T19:43:57Z |
format | Article |
id | doaj.art-e5f4b2e5013c4dd5bfff25f1d8e46ba6 |
institution | Directory Open Access Journal |
issn | 2199-1154 2198-9788 |
language | English |
last_indexed | 2024-03-08T19:43:57Z |
publishDate | 2023-10-01 |
publisher | Adis, Springer Healthcare |
record_format | Article |
series | Drugs - Real World Outcomes |
spelling | doaj.art-e5f4b2e5013c4dd5bfff25f1d8e46ba62023-12-24T12:30:25ZengAdis, Springer HealthcareDrugs - Real World Outcomes2199-11542198-97882023-10-0110454555510.1007/s40801-023-00393-zDiagnosis and Treatment of Advanced ALK Rearrangement-Positive Non-Small-Cell Lung Cancer in Portugal: Results of a National QuestionnaireAna Figueiredo0Ana Rodrigues1Carina Gaspar2Margarida Felizardo3Department of Pulmonology, Centro Hospitalar e Universitário de CoimbraDepartment of Medical Oncology, Instituto Português de Oncologia do PortoMedical & Scientific Management, Syneos HealthDepartment of Pulmonology, Hospital Beatriz ÂngeloAbstract Background Rearrangements in the anaplastic lymphoma kinase (ALK) gene define a molecular subgroup of non-small-cell lung carcinoma (NSCLC) that should be treated with ALK-targeting tyrosine kinase inhibitors (TKIs). Objective This study aimed to portray the Portuguese reality about the diagnosis and treatment of stage IV ALK-positive NSCLC. Methods Institutions that treat lung cancer in Portugal were invited to participate in an anonymous electronic questionnaire. A total of 22/35 geographically dispersed institutions responded. A descriptive statistical analysis of the results was performed. Results Reflex molecular testing was done in 54.6% of the institutions. Next-generation sequencing (NGS) was the preferred diagnostic method (90.9%). Typically, physicians obtained molecular study results within 14–21 days. Alectinib was the most commonly used first-line treatment. For patients with brain metastases, 86.4% of the physicians preferred alectinib and 13.6% preferred first-line brigatinib. In the case of asymptomatic oligoprogression in the central nervous system, 85.7% of physicians performed local treatment and kept the patient on a TKI; if symptomatic, 66.7% gave local treatment and stayed with the TKI, while 28.6% gave local treatment and altered the TKI. For patients with symptomatic systemic progression, 47.6% and 38.1% of physicians prescribed lorlatinib after initial treatment with alectinib or brigatinib, respectively. After progression on lorlatinib, 42.9% of respondents chose chemotherapy and 57.1% requested detection of resistance mutations. Conclusions NGS is widely used for the molecular characterization of ALK-positive NSCLC in Portugal. The country has access to up-to-date therapy. Overall, national clinical practice follows international recommendations for the diagnosis and treatment of ALK-positive NSCLC.https://doi.org/10.1007/s40801-023-00393-z |
spellingShingle | Ana Figueiredo Ana Rodrigues Carina Gaspar Margarida Felizardo Diagnosis and Treatment of Advanced ALK Rearrangement-Positive Non-Small-Cell Lung Cancer in Portugal: Results of a National Questionnaire Drugs - Real World Outcomes |
title | Diagnosis and Treatment of Advanced ALK Rearrangement-Positive Non-Small-Cell Lung Cancer in Portugal: Results of a National Questionnaire |
title_full | Diagnosis and Treatment of Advanced ALK Rearrangement-Positive Non-Small-Cell Lung Cancer in Portugal: Results of a National Questionnaire |
title_fullStr | Diagnosis and Treatment of Advanced ALK Rearrangement-Positive Non-Small-Cell Lung Cancer in Portugal: Results of a National Questionnaire |
title_full_unstemmed | Diagnosis and Treatment of Advanced ALK Rearrangement-Positive Non-Small-Cell Lung Cancer in Portugal: Results of a National Questionnaire |
title_short | Diagnosis and Treatment of Advanced ALK Rearrangement-Positive Non-Small-Cell Lung Cancer in Portugal: Results of a National Questionnaire |
title_sort | diagnosis and treatment of advanced alk rearrangement positive non small cell lung cancer in portugal results of a national questionnaire |
url | https://doi.org/10.1007/s40801-023-00393-z |
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