BACKGROUND: In patients with ALK-positive metastatic non-small cell lung cancer (mNSCLC), the majority of data on ALK inhibitor (ALKi) use and related survival outcomes are from clinical trials; information from community practice is sparse. This study therefore sought to assess ALK testing patterns, treatment characteristics, and overall survival (OS) in patients with mNSCLC treated with ceritinib in routine practice.
METHOD: In this retrospective cohort study, medical records for patients with ALK-positive mNSCLC (diagnosed during 2008-2016; aged ≥18 years) were selected from sites in Canada and Europe. Patients were treated with ceritinib in any line for mNSCLC and had at least 8 months of follow-up after ceritinib initiation, except for patients who died sooner than 8 months. Baseline patient characteristics, treatment patterns, and timing of ALK testing relative to start of therapy lines were descriptively assessed. OS was assessed using Kaplan-Meier methods.
RESULT: 87 patients were selected (median age: 53 years). Nearly 56% of patients had been tested for ALK mutation before initiating the first-line therapy (1L); 72% were tested before 2L and 77% before 3L. The most common regimens were cisplatin/pemetrexed (25%) in 1L, crizotinib (28%) in 2L, and ceritinib (35%) in 3L. Over two-thirds (68%) received treatment with at least 2 ALKis. The most commonly observed ALKi sequences were crizotinib followed by ceritinib (52%), ceritinib only (23%), and crizotinib followed by ceritinib followed by alectinib (12%). Median OS (95% CI) from mNSCLC diagnosis was 39 (33.1-50.1) months. Median OS (95% CI) from treatment initiation was 36 (28.2-48.9) months for 1L, 29 (22.1-42.8) months for 2L, and 23 (14.0-40.5) months for 3L.
CONCLUSION: Only slightly more than half of patients with ALK-positive mNSCLC were tested for ALK mutation before initiating the first-line therapy during the study period. ALKis were the preferred therapies in the second and third lines. Median OS following the first-line therapy initiation was nearly 3 years among the selected study patients.
