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Camidge DR, Kim DW, Tiseo M, Langer CJ, Ahn MJ, Shaw AT, Huber RM, Hochmair MJ, Lee DH, Bazhenova LA, Gold KA, Ou SHI, West HL, Reichmann W, Haney J, Clackson T, Kerstein D, Gettinger SN. Exploratory Analysis of Brigatinib Activity in Patients With Anaplastic Lymphoma Kinase-Positive Non-Small-Cell Lung Cancer and Brain Metastases in Two Clinical Trials. J Clin Oncol 2018; 36:2693-2701. [PMID: 29768119 DOI: 10.1200/jco.2017.77.5841] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In patients with crizotinib-treated, anaplastic lymphoma kinase gene ( ALK)-rearranged non-small-cell lung cancer (ALK-positive NSCLC), initial disease progression often occurs in the CNS. We evaluated brigatinib, a next-generation ALK inhibitor, in patients with ALK-positive NSCLC with brain metastases. Patients and Methods Patients with ALK-positive NSCLC received brigatinib (90 to 240 mg total daily) in a phase I/II trial (phI/II; ClinicalTrials.gov identifier: NCT01449461) and in the subsequent randomized phase II trial ALTA (ALK in Lung Cancer Trial of AP26113; ClinicalTrials.gov identifier: NCT02094573; patients in arm A received 90 mg once daily; patients in arm B received 180 mg once daily with 7-day lead-in at 90 mg). Primary end points (systemic objective response rates [ORRs]) were previously reported. Independent review committees assessed intracranial efficacy in patients with baseline brain metastases. Results Most patients with ALK-positive NSCLC had baseline brain metastases (50 of 79 [63%], phI/II; 80 of 112 [71%] and 73 of 110 [66%] in ALTA arms A and B, respectively), many of whom had no prior brain radiotherapy (23 of 50 [46%], phI/II; 32 of 80 [40%], ALTA arm A; 30 of 73 [41%], arm B). All patients, except four in phI/II, had received crizotinib. Among patients with measurable (≥ 10 mm) brain metastases, confirmed intracranial ORR was 53% (eight of 15; 95% CI, 27% to 79%) in phI/II, 46% (12 of 26; 95% CI, 27% to 67%) in ALTA arm A, and 67% (12 of 18; 95% CI, 41% to 87%) in arm B. Intracranial ORRs were similar in subsets without prior radiation or progression postradiation. Among patients with any baseline brain metastases, median intracranial progression-free survival (iPFS) was 14.6 months (95% CI, 12.7 to 36.8 months), phI/II; 15.6 months (95% CI, 9.0 to 18.3 months), ALTA arm A; 18.4 months (95% CI, 12.8 months to not reached), ALTA arm B. Conclusion Brigatinib yielded substantial intracranial responses and durable iPFS in ALK-positive, crizotinib-treated NSCLC, with highest iPFS in patients receiving 180 mg once daily (with lead-in).
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Affiliation(s)
- D Ross Camidge
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Dong-Wan Kim
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Marcello Tiseo
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Corey J Langer
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Myung-Ju Ahn
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Alice T Shaw
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Rudolf M Huber
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Maximilian J Hochmair
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Dae Ho Lee
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Lyudmila A Bazhenova
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Kathryn A Gold
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Sai-Hong Ignatius Ou
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Howard L West
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - William Reichmann
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Jeff Haney
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Tim Clackson
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - David Kerstein
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
| | - Scott N Gettinger
- D. Ross Camidge, University of Colorado Cancer Center, Aurora, CO; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center; Dae Ho Lee, Asan Medical Center, Seoul, South Korea; Marcello Tiseo, University Hospital of Parma, Parma, Italy; Corey J. Langer, University of Pennsylvania, Philadelphia, PA; Alice T. Shaw, Massachusetts General Hospital, Boston; William Reichmann, Jeff Haney, Tim Clackson, and David Kerstein, ARIAD Pharmaceuticals, Cambridge, MA; Rudolf M. Huber, University Hospital of Munich, Munich, Germany; Maximilian J. Hochmair, Otto Wagner Hospital, Vienna, Austria; Lyudmila A. Bazhenova and Kathryn A. Gold, University of California San Diego Moores Cancer Center, La Jolla; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Irvine, CA; Howard L. West, Swedish Cancer Institute, Seattle, WA; and Scott N. Gettinger, Yale Cancer Center, New Haven, CT
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