Evaluation of Efficacy of ALK Inhibitors According to Body Mass Index in ALK Rearranged NSCLC Patients-A Retrospective Observational Study

The impact of comprehensive healthy lifestyles on obstructive sleep apnea and the mediating role of BMI: insights from NHANES 2005-2008 and 2015-2018

OBJECTIVE

In this study, the associations between healthy lifestyles and obstructive sleep apnea (OSA) in middle-aged and elderly adults were investigated via data from the National Health and Nutrition Examination Survey (NHANES) for the periods of 2005-2008 and 2015-2018.

METHODS

A total of 6,406 participants aged 40 years and older were included in the analysis. Healthy lifestyle behaviors were assessed through diet quality, physical activity, sleep duration, alcohol consumption, smoking status, and body mass index (BMI). A composite healthy lifestyle score (ranging from 0 to 6) was created and categorized into insufficient (0-2), intermediate (3-4), and optimal (5-6) health groups. Weighted logistic regression models were used to examine the association between these lifestyle scores and OSA, adjusting for some demographic, socioeconomic, and clinical covariates. Additionally, mediation analysis was conducted to evaluate the role of BMI as a mediator in the relationship between the composite healthy lifestyle score and OSA, determining the proportion of the total effect mediated by BMI.

RESULTS

Participants were classified into insufficient (17.81%), intermediate (56.82%), and optimal (25.37%) lifestyle groups. Higher dietary quality (OR: 0.81, 95% CI: 0.66-0.99) and adequate weight (OR: 0.09, 95% CI: 0.07-0.11) were statistically associated with reduced OSA odds after adjustments, whereas the variables were not. Each one-point increase in the healthy lifestyle score was linked to a 33% reduction in OSA odds (OR: 0.67, 95% CI: 0.63-0.71). A significant linear trend was observed, with better adherence to healthy lifestyle correlating with lower odds of OSA (p for trend < 0.001). Compared with insufficient lifestyle, intermediate lifestyle was linked to a 27% reduction in OSA (OR: 0.73, 95% CI: 0.58-0.91), whereas optimal lifestyle was associated with a 74% reduction (OR: 0.26, 95% CI: 0.21-0.33). Mediation analysis revealed that BMI significantly mediated the relationship between healthy lifestyle score and OSA, accounting for approximately 59.2% of the total effect (P < 0.001). The direct effect of the healthy lifestyle score on OSA remained significant even when controlling for BMI (P < 0.001). Subgroup analyses confirmed consistent benefits across different demographic groups.

CONCLUSIONS

This study revealed that adherence to healthy lifestyles significantly reduces the odds of OSA, with optimal lifestyles leading to a marked decrease in the odds of OSA. Notably, BMI plays a critical mediating role in this relationship. These findings emphasize the importance of promoting healthy lifestyle interventions as a key strategy for the prevention and management of OSA.

Alectinib continuation beyond progression in ALK-positive non-small cell lung cancer with alectinib-refractory

Background

Alectinib, a next-generation anaplastic lymphoma kinase tyrosine kinase inhibitor (ALK-TKI), has demonstrated noteworthy efficacy in the treatment of non-small cell lung cancer (NSCLC). Unfortunately, 53.3% of untreated patients receiving first-line treatment with alectinib developed resistance to alectinib. However, despite the widespread use of alectinib, studies on the efficacy and safety of continuing alectinib with other necessary therapies after progression of alectinib and possible population of benefit are still limited.

Methods

This retrospective cohort study included fifteen patients with ALK-positive NSCLC from nine institutions in China who experienced disease progression after first- or second-line treatment and continued to receive alectinib treatment between 2019 and 2022. This study aimed to evaluate the median progression-free survival (mPFS), objective response rate (ORR), median overall survival (mOS), and adverse events (AEs) of continuing alectinib combined with other therapies after the emergence of drug resistance.

Results

Among fifteen patients eligible for this study, all patients started continuing treatment with alectinib after oligoprogression or central nervous system (CNS) progression. The mPFS for the whole cohort receiving continuing alectinib with other necessary therapies was 8 months [95% confidence interval (CI): 4 to not applicable (NA)], with an ORR of 46.7%. The mOS was not reached. During continuing alectinib treatment, only one patient experienced grade 2 elevation of aspartate aminotransferase (AST) and serum glutamic-oxaloacetic transaminase (SGOT).

Conclusions

The continuation of alectinib treatment combined with other necessary therapies demonstrates favorable response and safety in patients with ALK-positive NSCLC who experienced oligoprogression or CNS progression following alectinib in first- or second-line therapy. Instead of immediately switching to another ALK-TKI, continuing alectinib combined with other necessary therapies may offer greater survival benefits to the patients.