2019 ASCO Annual Meeting!
Session: Lung Cancer—Non-Small Cell Metastatic
Type: Poster Session
Time: Sunday June 2, 8:00 AM to 11:00 AM
Location: Hall A
The impact of sequential therapy of crizotinib followed by alectinib: Real-world data analysis of 840 ALK-inhibitor naïve patients with NSCLC harboring ALK-rearrangement (WJOG9516L).
Metastatic Non-Small Cell Lung Cancer
Lung Cancer—Non-Small Cell Metastatic
2019 ASCO Annual Meeting
Poster Board Number:
Poster Session (Board #361)
J Clin Oncol 37, 2019 (suppl; abstr 9038)
Author(s): Kentaro Ito, Takeharu Yamanaka, Satomi Watanabe, Yoshihiro Hattori, Kazumi Nishino, Haruki Kobayashi, Yuko Oya, Toshihide Yokoyama, Takashi Seto, Koichi Azuma, Tomoya Fukui, Toshiyuki Kozuki, Atsushi Nakamura, Isamu Okamoto, Katsuya Hirano, Takashi Yokoi, Haruko Daga, Shinya Sakata, Kazuhiko Nakagawa, Nobuyuki Yamamoto; Matsusaka Municipal Hospital, Matsusaka City, Mie, Japan; Yokohama City University School of Medicine, Yokohama, Japan; Department of Medical oncology, Kindai University, Faculty of Medicine, Osakasayama City, Osaka, Japan; Hyogo Cancer Center, Akashi, Japan; Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan; Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan; Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan; Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan; National Kyushu Cancer Center, Fukuoka, Japan; Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan; Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan; Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan; Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan; Kyushu University Hospital, Fukuoka, Japan; Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan; Department of Thoracic Oncology, Kansai Medical University Hirakata Hospital, Osaka, Japan; Department of Clinical Oncology, Osaka City General Hospital, Osaka, Japan; Kumamoto University Hospital, Kumamoto, Japan; Kindai University Hospital, Osaka, Japan; Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
Background: Previous clinical trials demonstrated that alectinib (ALEC) had a longer time-to-progression than crizotinib (CRZ) in 1st-line settings. Information on long-term overall survival (OS), however, is still limited with a few studies having reported that the sequential strategy of “CRZ followed by other ALK-inhibitor” can provide extended OS. In Japan, ALEC was approved for a 1st-line setting earlier than in other countries. Methods: We reviewed the clinical data of ALK-rearranged NSCLC patients who received CRZ or ALEC between May 2012 and Dec 2016. Patients were divided into two groups according to the first-administered ALK inhibitor, the CRZ or ALEC group. In order to evaluate the efficacy of the sequential strategy of “CRZ followed by ALEC”, the combined time to treatment failure (TTF) was calculated in the CRZ group as defined by the sum of the “TTF of CRZ” plus the “TTF of ALEC” if patients were treated with ALEC followed by CRZ. In the ALEC group, the “TTF of ALEC” was calculated. The primary endpoint is the comparison between the combined TTF in the CRZ group with the TTF in the ALEC group. Results: Of 864 patients enrolled from 61 institutions, 840 patients were analyzed. Median age was 61 (range, 20-94); 56% were female; and 95% had adenocarcinoma. There were 535/305 patients in the CRZ/ALEC group. In the CRZ group, 282 patients received ALEC after CRZ failure. The combined TTF in the CRZ group was significantly longer than TTF in the ALEC group; median, 34.4 vs 27.2 months (mo); hazard ratio (HR), 0.709 [95%CI;0.559- 0.899]; P= 0.0044. However, there was no significant difference in OS between the patients who received ALEC after CRZ in the CRZ group and the patients in the ALEC group; median, 88.4 months vs. not reached; HR 1.048 [95%CI;0.758-1.451]; P= 0.7770. In the whole population, the CRZ group had a significantly shorter OS than the ALEC group; median, 53.6 mo vs not reached HR, 1.821 [95%CI;1.372-2.415]; P< 0.0001. Conclusions: The combined TTF in the CRZ group was significantly longer than TTF in the ALEC group, however, OS benefit of sequential therapy of CRZ followed by ALEC was not shown. Clinical trial information: UMIN000028605.