1
|
Jeon DS, Park C, Kim SJ, Park CK, Chang YS, Jung CY, Lee SY, Lee S, Ryu J, Lee JE, Lee KY, Jang TW, Jang SH, Yoon SH, Lee SH, Choi C, Kim HR, Kim YJ. Real-world outcome of crizotinib for anaplastic lymphoma kinase-positive lung cancer: Multicenter retrospective analysis in South Korea. Thorac Cancer 2024; 15:448-457. [PMID: 38171544 PMCID: PMC10883859 DOI: 10.1111/1759-7714.15213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND About 3%-5% of non-small cell lung cancer (NSCLC) presents positive anaplastic lymphoma kinase (ALK). Recently, several target agents have been approved as a treatment for ALK-positive NSCLC. This study aimed to analyze the real-world efficacy and outcome when administered crizotinib, the first approved target agent for ALK-positive NSCLC, according to first- or late-line treatment. METHODS A total of 290 patients with ALK-positive advanced NSCLC who were treated with crizotinib in 15 institutions in South Korea from January 2009 to December 2018 were enrolled. RESULTS The median age of patients was 57.0 years, and 50.3% were male. The median follow-up duration was 29.3 months. Among them, 113 patients received crizotinib as first-line therapy. The objective response rate (ORR) was 60.1% (57.0% for first-line recipients, 61.8% for second-/later-line). Median (95% CI) progression-free survival (PFS) was 13.7 (11.6-17.0) months. For first-line recipients, overall survival (OS) was 26.3 (17.6-35.0) months. No significant difference in ORR, PFS and OS, according to the setting of crizotinib initiation, was observed. In a multivariate Cox regression analysis, old age, male gender, initially metastatic, and number of metastatic organs were associated with poor PFS and OS. The most common adverse events were nausea and vomiting, and severe adverse event leading to dose adjustment was hepatotoxicity. CONCLUSIONS ORR, PFS, OS, and adverse event profiles were comparable to previous clinical trials. Our findings could aid in the efficient management of ALK-positive lung cancer patients.
Collapse
Affiliation(s)
- Da Som Jeon
- Department of Pulmonary and Critical Care MedicineNowon Eulji Medical Center, University of EuljiSeoulSouth Korea
| | - Cheol‐kyu Park
- Department of Pulmonary and Critical Care MedicineChonnam National University Hwasun hospital, Chonnam National UniversityJeollanam‐doRepublic of Korea
| | - Seung Joon Kim
- Department of Internal MedicinePostech‐Catholic Biomedical Engineering Institute, College of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
| | - Chan Kwon Park
- Department of Pulmonary and Critical Care MedicineCatholic University of Korean Yeouido Saint Mary's HospitalSeoulKorea
| | - Yoon Soo Chang
- Department of Internal MedicineYonsei University College of Medicine, 8th Floor Annex Building, Yongdong Severance HospitalSeoulRepublic of Korea
| | - Chi Young Jung
- Department of Internal MedicineDaegu Catholic University School of MedicineDaeguKorea
| | - Sung Yong Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of MedicineSeoulKorea
| | - Shin‐Yup Lee
- Division of Pulmonary and Critical Care MedicineKyungpook National University Chilgok HospitalDaeguKorea
| | - Jeong‐Seon Ryu
- Department of Pulmonary and Critical Care MedicineInha University HospitalIncheonRepublic of Korea
| | - Jeong Eun Lee
- Department of Internal MedicineChungnam National University HospitalDaejeonRepublic of Korea
| | - Kye Young Lee
- Department of Pulmonary MedicineKonkuk University School of MedicineSeoulRepublic of Korea
| | - Tae Won Jang
- Department of Internal MedicineKosin University Medical CollegePusanKorea
| | - Seung Hun Jang
- Department of PulmonaryAllergy and Critical Care Medicine, Hallym University Sacred Heart HospitalAnyangRepublic of Korea
| | - Seong Hoon Yoon
- Department of Internal MedicineSchool of Medicine, Pusan National UniversityYangsanRepublic of Korea
| | - Sang Hoon Lee
- Division of Pulmonology, Institute of Chest Disease, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Chang‐min Choi
- Department of Pulmonary and Critical Care MedicineAsan Medical Centre, University of Ulsan College of MedicineSeoulRepublic of Korea
- Department of OncologyAsan Medical Centre, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Hyeong Ryul Kim
- Department of Pulmonary and Critical Care MedicineAsan Medical Centre, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Yeon Joo Kim
- Department of Pulmonary and Critical Care MedicineNowon Eulji Medical Center, University of EuljiSeoulSouth Korea
| |
Collapse
|
2
|
Lasala R, Zovi A, Isgrò V, Romagnoli A, Musicco F, Santoleri F. Time to treatment discontinuation in first-line non-small cell lung carcinoma: an overview. Curr Med Res Opin 2023; 39:1603-1612. [PMID: 36932463 DOI: 10.1080/03007995.2023.2192610] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Time To Discontinuation (TTD) is defined as the time from the start of treatment to the end of treatment, usually occurring due to loss of efficacy or occurrence of adverse events. It has become an important surrogate efficacy endpoint especially in real-world studies due to its correlation with endpoints such as Progression Free Survival (PFS). The aim of the study is to conduct a literature review of all studies reporting TTD in first-line therapy of Non-Small Cell Lung Cancer (NSCLC). METHODS All articles that reported TTD for any first-line treatment of NSCLC as of 30 June 2022 were extracted from the PubMed search engine. From these articles, the drugs, study type, and TTD values were extracted. A descriptive analysis of the studies was made, dividing the TTD by subgroup according to the type of treatment (traditional chemotherapy, target therapy, immunotherapy) and study design (clinical trials, real world studies). RESULTS Fifty-five studies were considered for the analysis, of which 12 were published in 2021; 28 were clinical trials and 27 were real-world studies. Thirty of the studies considered involved conventional chemotherapy and expressed TTD values from 1.4 to 4.5 months, 5 of the studies considered involved immunotherapy with TTD values from 2.1 to 7.4 months and 18 of the studies considered target therapy, with TTD values from 4 to 31 months. The clinical trials reported TTD values from 1.4 to 16 months and the real-world studies from 2 to 31 months. CONCLUSION Studies reporting TTD are increasing, most notably real-world studies. Given the increasing importance of TTD as an efficacy endpoint, it becomes critical to measure and monitor it in various therapeutic settings such as NSCLC. This is the first study to review all TTD values of drugs used in first-line NSCLC.
Collapse
Affiliation(s)
- Ruggero Lasala
- Hospital Pharmacy of Corato, Local Health Unit of Bari, Italy
| | - Andrea Zovi
- Ministry of Health, Ministero della Salute, Rome, Italy
| | - Valentina Isgrò
- Clinical Pharmacy, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Alessia Romagnoli
- Territorial Pharmaceutical Service, Local Health Unit of Lanciano Vasto Chieti, Chieti, Italy
| | - Felice Musicco
- Hospital Pharmacy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | |
Collapse
|
3
|
Amorrortu R, Garcia M, Zhao Y, El Naqa I, Balagurunathan Y, Chen DT, Thieu T, Schabath MB, Rollison DE. Overview of approaches to estimate real-world disease progression in lung cancer. JNCI Cancer Spectr 2023; 7:pkad074. [PMID: 37738580 PMCID: PMC10637832 DOI: 10.1093/jncics/pkad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Randomized clinical trials of novel treatments for solid tumors normally measure disease progression using the Response Evaluation Criteria in Solid Tumors. However, novel, scalable approaches to estimate disease progression using real-world data are needed to advance cancer outcomes research. The purpose of this narrative review is to summarize examples from the existing literature on approaches to estimate real-world disease progression and their relative strengths and limitations, using lung cancer as a case study. METHODS A narrative literature review was conducted in PubMed to identify articles that used approaches to estimate real-world disease progression in lung cancer patients. Data abstracted included data source, approach used to estimate real-world progression, and comparison to a selected gold standard (if applicable). RESULTS A total of 40 articles were identified from 2008 to 2022. Five approaches to estimate real-world disease progression were identified including manual abstraction of medical records, natural language processing of clinical notes and/or radiology reports, treatment-based algorithms, changes in tumor volume, and delta radiomics-based approaches. The accuracy of these progression approaches were assessed using different methods, including correlations between real-world endpoints and overall survival for manual abstraction (Spearman rank ρ = 0.61-0.84) and area under the curve for natural language processing approaches (area under the curve = 0.86-0.96). CONCLUSIONS Real-world disease progression has been measured in several observational studies of lung cancer. However, comparing the accuracy of methods across studies is challenging, in part, because of the lack of a gold standard and the different methods used to evaluate accuracy. Concerted efforts are needed to define a gold standard and quality metrics for real-world data.
Collapse
Affiliation(s)
| | - Melany Garcia
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Yayi Zhao
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Issam El Naqa
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Dung-Tsa Chen
- Department of Biostatistics and Bionformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Thanh Thieu
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Dana E Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| |
Collapse
|
4
|
Kapoor A, Noronha V, Patil V, Menon N, Nandhana R, Kumar A, Mahajan A, Janu A, Kumar R, Prabhash K. Long-Term Outcomes of Crizotinib Treated ALK-Positive Lung Cancer Patients: A Retrospective Audit of Prospective Data from Resource-Constrained Settings. South Asian J Cancer 2023; 12:179-184. [PMID: 37969671 PMCID: PMC10635771 DOI: 10.1055/s-0042-1753478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Akhil KapoorPurpose Crizotinib has been one of the standard treatment options for the treatment of anaplastic lymphoma kinase (ALK) rearranged non-small cell lung cancer (NSCLC) based on higher progression-free survival (PFS) and objective response rates in phase III clinical trials. However, real-world data about the long-term efficacy and toxicity of crizotinib is limited. Methods A retrospective analysis of all patients with ALK-positive NSCLC, treated with crizotinib between March 2014 and December 2016, was performed. The main outcomes measured were PFS, overall survival (OS), and adverse effects. Results One hundred and eighty-eight patients treated with crizotinib during this period were included in this study. The median age was 50 years (range: 24-74) with a majority being males (73.2%) and 80.3% with a performance status of 0 to 1. The median duration of follow-up was 49.4 months (range: 3.4-86.3%). The median PFS of crizotinib was 17.3 months (95% confidence interval [CI], 13.0-21.6) and 12.8 months (95% CI, 8.1-17.6) when used in first line or subsequent lines, respectively. The median OS was 38.3 months (95% CI, 28.4-48.2). The patients who received crizotinib in the first line had a median OS of 45.5 months (95% CI, 29.6-61.4) as compared with 29.7 months (95% CI, 22.2-37.2) for those who received in subsequent line (hazard ratio, 0.6, 95% CI, 0.4-0.9, p =0.022). The most common all grade toxicities include transaminitis, anemia, fatigue, and corrected QT prolongation. Conclusion This real-world study confirms the long-term beneficial effects of crizotinib in ALK rearranged NSCLC with favorable toxicity profile like that of the registration studies, in resource constrained settings.
Collapse
Affiliation(s)
- Akhil Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center and Homi Bhabha Cancer Hospital (A Unit of Tata Memorial Center, Mumbai), Varanasi, Uttar Pradesh, India
| | - Vanita Noronha
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nandini Menon
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ravindra Nandhana
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amit Kumar
- Department of Medical Oncology, Homi Bhabha Cancer Hospital, Muzaffarpur, and Jay Prabha Medanta Hospital, Patna, Bihar, India
| | - Abhishek Mahajan
- Department of Radiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Janu
- Department of Radiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajiv Kumar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
5
|
Gogebakan KC, Lange J, Slatore CG, Etzioni R. Modeling the impact of novel systemic treatments on lung cancer screening benefits. Cancer 2023; 129:226-234. [PMID: 36320180 DOI: 10.1002/cncr.34527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/01/2022] [Accepted: 09/28/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Since low-dose computed tomography (LDCT) screening was shown to be effective in the National Lung Screening Trial (NLST), novel targeted therapies and immunotherapies for advanced lung cancer have become available. This study investigated the impact of these treatment advances on the expected benefits of LDCT screening. METHODS A microsimulation model of LDCT screening for high-risk individuals under standard systemic treatments (chemotherapy and radiation therapy) and novel treatments (immunotherapy and targeted therapy) was used. The model assumed a reduction in advanced-stage disease consistent with the NLST, and given the stage at diagnosis, it projected survival. The disease-specific relative mortality reduction (MR) due to LDCT screening was projected in the trial setting and in a population eligible for LDCT screening under the current US Preventive Services Task Force (USPSTF) recommendations. RESULTS The availability of novel treatments reduced the MR in the LDCT arm of the NLST from 15% to 13.5% and the number of lung cancer deaths prevented from 310 to 224 per 100,000 persons screened. Over 10 years, population LDCT screening based on USPSTF recommendations prevented 374 lung cancer deaths per 100,000 under standard treatments (13.3% MR) and 236 per 100,000 under fully adopted novel treatments (10.6% MR). The number needed to screen to avert one death over 10 years was 270 under standard treatments and 440 under novel treatments. CONCLUSIONS The transition from standard systemic treatments to novel treatments is expected to reduce the relative and absolute mortality benefits of LDCT screening. Benefit-harm tradeoffs of LDCT screening are likely to change as novel treatments become widespread.
Collapse
Affiliation(s)
- Kemal Caglar Gogebakan
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jane Lange
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA.,Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Ruth Etzioni
- Program in Biostatistics, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| |
Collapse
|
6
|
Identification of ALK-positive patients with advanced NSCLC and real-world clinical experience with crizotinib in Spain (IDEALK study). Lung Cancer 2022; 173:83-93. [PMID: 36162227 DOI: 10.1016/j.lungcan.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine the incidence of ALK translocations in patients with advanced/metastatic NSCLC in Spain, to describe the clinical characteristics of these patients, and to evaluate the effectiveness and safety of treatment with crizotinib in a real-world setting. METHODS This is an observational prospective and retrospective cohort study to determine the incidence of ALK translocations and to analyze the effectiveness and safety of crizotinib in a real-world setting. Patient characteristics, treatment patterns, time to best overall response, duration of treatment, objective response rates (ORR), rates of adverse events (AE), progression free survival (PFS) and overall survival (OS) were evaluated in the ALK study cohort of patients treated with crizotinib (prospective and retrospective). ALK incidence and quality of life (QoL) questionnaires were measured from patients included in the prospective cohort. RESULTS The incidence of ALK translocations was 5.5 % (31 of 559 patients). Compared with ALK-negative patients, ALK-positive patients were significantly younger, predominantly female, and non-smokers. In the crizotinib effectiveness and safety study, 91 patients (42 prospective, 49 retrospective) with ALK-positive NSCLC (43.9 % in first-line, 56.1 % in second or more lines) were included. The ORR was 59.3 % and the median duration of response was 13.5 months (IQR, 5.3-26.2). The median PFS was 15.8 months (95 % CI, 11.8-22.3) and the median OS was 46.5 months, with 53 patients (58.2 %) still alive at data cut-off date. Frequently reported AEs included elevated transaminases, gastrointestinal disorders, and asthenia. Most patients (76.5 %) reported improved or stable scores for global QoL during treatment. CONCLUSIONS The observed incidence of ALK translocations in NSCLC patients is aligned with published reports. This analysis of the real-world clinical experience in Spain confirms the therapeutic benefit and safety of crizotinib in advanced/metastatic ALK-positive NSCLC. CLINICALTRIALS gov: NCT02679170.
Collapse
|
7
|
Hofmarcher T, Lindgren P, Wilking N. Systemic anti-cancer therapy patterns in advanced non-small cell lung cancer in Europe. J Cancer Policy 2022; 34:100362. [PMID: 36087918 DOI: 10.1016/j.jcpo.2022.100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Systemic anti-cancer therapy (SACT) is the recommended treatment modality in patients with advanced non-small cell lung cancer (aNSCLC) in clinical guidelines. SACT options in aNSCLC have multiplied in recent years with the introduction of immunotherapy and targeted therapy. This article presents findings from the first comparative analysis of SACT patterns in Europe. METHODS SACT rates in aNSCLC were estimated as the ratio between the number of patients treated with SACT (chemotherapy, immunotherapy, targeted therapy) and the number of potentially eligible patients for SACT in 11 countries (Belgium, Bulgaria, Finland, Hungary, Ireland, Netherlands, Norway, Poland, Portugal, Romania, UK) between 2014 and 2020. Treated patients were estimated by combining national sales volume data of cancer drugs and average drug use per patient based on clinical trials. Potentially eligible patients were estimated from national epidemiological data. RESULTS SACT rates in aNSCLC differed greatly, ranging from around 30 % in Hungary, Poland, and the UK to almost 60 % in Ireland, Norway, and Portugal in 2014. SACT rates seemed to increase over time in most countries, but differences were still large by 2020, ranging from around 40 % in the UK to 75 % or more in Belgium, Norway, and Portugal. Even in countries with the highest SACT rates, far from all patients seemed to receive guideline-recommended SACT options, as underuse of immunotherapy and targeted therapy was common. CONCLUSION Up to 35 % of eligible patients with aNSCLC receives no SACT in certain European countries, although improvements have been achieved over time. The use of immunotherapy and targeted therapy is suboptimal even in countries with high SACT rates, indicating room to improve the quality of care and patient outcomes. POLICY SUMMARY Measuring if and what kind of therapy cancer patients have access to is vital to assess quality of care. The care of aNSCLC patients seems to be suboptimal in Europe, due to factors such as exclusion of patients with moderate performance status from SACT, limited resources for diagnostic testing, long reimbursement timelines and slow adoption of new medicines in clinical practice.
Collapse
Affiliation(s)
- Thomas Hofmarcher
- IHE - The Swedish Institute for Health Economics, Råbygatan 2, SE-22361, Lund, Sweden.
| | - Peter Lindgren
- IHE - The Swedish Institute for Health Economics, Råbygatan 2, SE-22361, Lund, Sweden; Karolinska Institutet, Solnavägen 1, SE-17177, Solna, Sweden
| | - Nils Wilking
- Karolinska Institutet, Solnavägen 1, SE-17177, Solna, Sweden
| |
Collapse
|
8
|
Gibson AJ, Box A, Dean ML, Elegbede AA, Hao D, Sangha R, Bebb DG. Retrospective Real-World Outcomes for Patients With ALK-Rearranged Lung Cancer Receiving ALK Receptor Tyrosine Kinase Inhibitors. JTO Clin Res Rep 2021; 2:100157. [PMID: 34590010 PMCID: PMC8474209 DOI: 10.1016/j.jtocrr.2021.100157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction This study explored the use, safety, and efficacy of initial use of an ALK-inhibiting targeted therapy (ALK tyrosine kinase inhibitor [TKI]) in patients with ALK-rearranged NSCLC in a population-based, real-world clinical population within the province of Alberta, Canada. Methods Demographic, clinical, treatment, and outcome data of the patients with advanced or metastatic ALK-rearranged NSCLC receiving their first ALK TKI between 2014 and 2019 were included in the analysis. Results A total of 92 patients with ALK-rearranged NSCLC treated with ALK TKI (78% crizotinib, 22% alectinib) were identified. In the ALK-rearranged cohort, 1-year survival rate was 73% and median overall survival (OS) and progression-free survival (PFS) were 48.5 months and 17.0 months, respectively. An objective response rate of 49% was observed, and adverse events were reported in 70% of the patients, primarily of low grade (84%). Case-matched comparison to patients with ALK-wildtype disease treated with cytotoxic chemotherapy revealed the benefit of ALK TKI in the context of an ALK rearrangement (ALK-rearranged versus ALK-wildtype) (median post-treatment initiation OS: 46.8 versus 14.2 mo, p < 0.001). Outcomes, measured from the time of ALK TKI initiation, differed by Eastern Cooperative Oncology Group (ECOG) (ECOG < 2 versus ECOG ≥ 2) (median OS: not reached versus 6.8 mo, p < 0.001; median PFS 17.6 versus 7.4 mo, p = 0.02), disease presentation (relapsed versus de novo) (median PFS: 30.8 versus 15.0 mo, p = 0.04), and brain metastasis onset (brain metastases development during ALK TKI versus baseline brain metastases) (not reached versus 12.8 mo, p = 0.04). Conclusions Clinical trials have firmly established that ALK TKIs are safe, well tolerated, and effective; these findings reveal that their impact in a real-world setting is just as profound. The availability and use of ALK TKI therapies contribute to the impressive gains in survival experienced by contemporary patients with ALK-rearranged disease, rendering patients with this oncodriven form of NSCLC among the longest surviving patients with lung cancer.
Collapse
Affiliation(s)
- Amanda J.W. Gibson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adrian Box
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Molecular Pathology Lab, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - Michelle L. Dean
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anifat A. Elegbede
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Desiree Hao
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Randeep Sangha
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - D. Gwyn Bebb
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
- Corresponding author. Address for correspondence: D. Gwyn Bebb, MD, PhD, Professor of Medicine, University of Calgary Tom Baker Cancer Centre, 1331, 29th St NW, Calgary, T2N 4N2 Alberta, Canada.
| |
Collapse
|
9
|
Schwarz S, Oppelt KA, Heinig M, Haug U. Potential of German claims data to characterize utilization of new cancer drugs: the example of crizotinib. Future Oncol 2021; 17:2305-2313. [PMID: 33784820 DOI: 10.2217/fon-2020-1052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: Premarketing clinical trials are typically conducted under controlled conditions and in selected study populations, so real-world information on the utilization of new cancer drugs is limited. We aimed to explore the potential of German claims data in this regard, exemplified by the ALK inhibitor crizotinib, used in non-small-cell lung cancer therapy. Materials & methods: We identified patients treated with crizotinib in the German Pharmacoepidemiological Research Database (2004-2017; 20% of the German population) and assessed patient characteristics, treatment and survival. Results: We identified 348 crizotinib-treated patients (56% female; 25% first-line users). After 2 years, overall survival was 48%, with higher survival in men than in women (58 vs 40%). Overall, 76% of patients discontinued crizotinib treatment. Of those, 41% received another ALK inhibitor afterward. Conclusion: The results underline the potential of German claims data for real-world monitoring of oncological drug utilization.
Collapse
Affiliation(s)
- Sarina Schwarz
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research & Epidemiology - BIPS, 28359, Bremen, Germany
| | - Katja A Oppelt
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research & Epidemiology - BIPS, 28359, Bremen, Germany
| | - Miriam Heinig
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research & Epidemiology - BIPS, 28359, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research & Epidemiology - BIPS, 28359, Bremen, Germany.,Faculty of Human & Health Sciences, University of Bremen, 28359, Bremen, Germany
| |
Collapse
|
10
|
Ehrenstein V, Huang K, Kahlert J, Bahmanyar S, Karlsson P, Löfling L, Nunes AP, Enger C, Bezemer ID, Kuiper JG, Hoti F, Juuti R, Korhonen P, Mo J, Schachterle SE, Wilner KD, Rørth M, Sørensen HT. Outcomes in patients with lung cancer treated with crizotinib and erlotinib in routine clinical practice: A post-authorization safety cohort study conducted in Europe and in the United States. Pharmacoepidemiol Drug Saf 2021; 30:758-769. [PMID: 33428292 DOI: 10.1002/pds.5193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/22/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE We examined safety outcomes of interest (SOI) and overall survival (OS) among lung cancer patients initiating crizotinib and erlotinib in routine clinical practice. METHODS This descriptive cohort study used routinely collected health data in Denmark, Finland, Sweden, the Netherlands, and the United States (US) during 2011-2017, following crizotinib commercial availability in each country. Among crizotinib or erlotinib initiators, we reported baseline characteristics and incidence rates and cumulative incidences of the SOI - hepatotoxicity, pneumonitis/interstitial lung disease, QT interval prolongation-related events, bradycardia, vision disorders, renal cysts, edema, leukopenia, neuropathy, photosensitivity, malignant melanoma, gastrointestinal perforation, cardiac failure and OS. Results from the European Union (EU) countries were combined using meta-analysis; results from the US were reported separately. RESULTS There were 456 patients in the crizotinib cohort and 2957 patients in the erlotinib cohort. Rates of the SOI per 1000 person-years in the crizotinib cohort ranged from 0 to 65 in the EU and from 0 to 374 in the US. Rates of the SOI per 1000 person-years in the erlotinib cohort ranged from 0 to 91 in the EU and from 3 to 394 in the US. In the crizotinib cohort, 2-year OS was ~50% in both EU and US. In the erlotinib cohort, 2-year OS was 21% in the EU and 35% in the US. CONCLUSIONS This study describes clinical outcomes among lung cancer patients initiating crizotinib or erlotinib in routine clinical practice. Differences between SOI rates in EU and US may be partially attributable to differences in the underlying databases.
Collapse
Affiliation(s)
- Vera Ehrenstein
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Kui Huang
- Pfizer Inc., New York, New York, USA
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Shahram Bahmanyar
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital SE, Stockholm, Sweden
| | - Pär Karlsson
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital SE, Stockholm, Sweden
| | - Lukas Löfling
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital SE, Stockholm, Sweden
| | | | | | - Irene D Bezemer
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | | | | | | | | | | | - Stephen E Schachterle
- Pfizer Inc., New York, New York, USA.,Department of Epidemiology and Biostatistics, School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | | | - Mikael Rørth
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| |
Collapse
|
11
|
Jahanzeb M, Lin HM, Pan X, Yin Y, Wu Y, Nordstrom B, Socinski MA. Real-World Treatment Patterns and Progression-Free Survival Associated with Anaplastic Lymphoma Kinase (ALK) Tyrosine Kinase Inhibitor Therapies for ALK+ Non-Small Cell Lung Cancer. Oncologist 2020; 25:867-877. [PMID: 32490560 DOI: 10.1634/theoncologist.2020-0011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/01/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Little is known about real-world treatment and outcomes of patients with anaplastic lymphoma kinase-positive (ALK+) advanced non-small cell lung cancer (NSCLC). PATIENTS AND METHODS This retrospective study of the Flatiron Health EHR-derived deidentified database included patients with a lung cancer diagnosis and confirmed advanced NSCLC who received ALK tyrosine kinase inhibitor (TKI) therapy (January 1, 2011, through June 30, 2018). Patient characteristics and treatment patterns were characterized. Real-world progression-free survival (rwPFS) and time to discontinuation were calculated using the Kaplan-Meier method. RESULTS First-line ALK TKI therapy was administered to 581 patients (27.5% had brain metastasis on or prior to initiation) and second-line ALK TKI therapy to 254 patients post crizotinib (45.7% had brain metastasis on or prior to second-line ALK TKI initiation). Crizotinib (84.6%; n = 492) was the most commonly administered first-line ALK TKI therapy. For second-line ALK TKI post crizotinib (n = 254), 49.6% received ceritinib, 41.7% received alectinib, 5.9% received crizotinib retreatment, and 2.8% received brigatinib. Median (95% confidence interval [CI]) rwPFS was 7.47 (6.48-8.32) months for first-line and 7.30 (5.72-8.42) months for second-line ALK TKI. Median (95% CI) rwPFS was significantly longer among first-line ALK TKI patients without than with brain metastasis (8.52 [7.57-10.59] vs. 4.97 [3.75-5.99] months; p < .0001) and patients with brain metastasis on or prior to first-line ALK TKI therapy had a significantly increased risk of progression (hazard ratio ± SE, 1.976 ± 0.112; p < .0001). CONCLUSION Median rwPFS in patients with advanced ALK+ NSCLC was < 8 months for first- and second-line ALK TKI therapy and was even shorter in patients with brain metastasis, highlighting the need for more effective treatments in this patient population. IMPLICATIONS FOR PRACTICE Results presented herein describe real-world treatment of advanced ALK+ NSCLC with ALK TKI therapies from January 2011 through June 2018. Crizotinib was the most commonly prescribed first-line ALK TKI therapy in this patient population, but the majority of data analyzed were obtained prior to Food and Drug Administration approval of alectinib and ceritinib in the first-line ALK TKI setting. Physicians should monitor patients closely to help identify when a change in treatment should occur.
Collapse
Affiliation(s)
- Mohammad Jahanzeb
- Florida Precision Oncology, a division of 21st Century Oncology, Boca Raton, Florida, USA
| | - Huamao M Lin
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - Xiaoyun Pan
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - Yu Yin
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - Yanyu Wu
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - Beth Nordstrom
- Real-World Evidence, Evidera, Waltham, Massachusetts, USA
| | - Mark A Socinski
- AdventHealth Hospital Cancer Institute, Orlando, Florida, USA
| |
Collapse
|
12
|
Tsimafeyeu I, Moiseenko F, Orlov S, Filippova E, Belonogov A, Nebesnykh A, Khalimov A, Karabina E, Shikina V, Abdelgafur A, Statsenko G, Titova I, Isaichikov D, Makarnyaeva G, Mordovskiy A, Barkovskaya O, Smirnov A, Gikalo M, Savelov N, Kosov D, Imyanitov E, Demidova I, Tjulandin S. Overall Survival of Patients With ALK-Positive Metastatic Non-Small-Cell Lung Cancer in the Russian Federation: Nationwide Cohort Study. J Glob Oncol 2020; 5:1-7. [PMID: 31095455 PMCID: PMC6550093 DOI: 10.1200/jgo.19.00024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The overall survival (OS) results in patients with ALK-positive metastatic non–small-cell lung cancer (NSCLC) have rarely been reported. The aim of this prospective-retrospective cohort study was to obtain real-world data on the use of crizotinib or chemotherapy in patients with ALK-positive metastatic NSCLC in Russia. PATIENTS AND METHODS Patients with epidermal growth factor receptor–negative metastatic NSCLC were screened in 23 cancer centers. To be eligible, patients were required to have confirmation of ALK rearrangement. Patients were treated with crizotinib (250 mg twice daily; n = 96) or the investigator’s choice of platinum-based chemotherapy (n = 53). The primary end point was OS. RESULTS A total of 149 ALK-positive patients were included. Mean age was 53 years in both groups. Patients were predominately women (59%) and never-smokers (74%), and most patients had adenocarcinoma histology (95%). At a median follow-up time of 15 months, 79 of the 149 patients included in the analysis had died. Median OS from the start of treatment was 31 months (95% CI, 28.5 to 33.5 months) in the crizotinib group and 15.0 months (95% CI, 9.0 to 21.0 months) in the chemotherapy group (P < .001). The objective response rate was 34% in the crizotinib group. Among patients with brain metastasis, one complete response (6%) and five partial responses (31%) were achieved. Grade 3 adverse events were observed in three patients (3%) in the crizotinib group. CONCLUSION The improved OS observed in crizotinib clinical trials in ALK-positive NSCLC was also observed in the less selective patient populations treated in daily practice in Russia. The use of standard chemotherapy in these patients remains common but seems inappropriate as a result of the effectiveness of newer treatments, such as crizotinib.
Collapse
Affiliation(s)
| | | | - Sergei Orlov
- Pavlov First Saint Petersburg State Medical University, St Petersburg, Russia
| | - Elena Filippova
- Pavlov First Saint Petersburg State Medical University, St Petersburg, Russia
| | | | | | | | | | | | | | | | - Irina Titova
- A.I. Kryzhanovsky Krasnoyarsk Cancer Center, Krasnoyarsk, Russia
| | | | | | | | | | | | | | | | - Dmitry Kosov
- Aston Health Contract Research Organization, Moscow, Russia
| | | | | | - Sergei Tjulandin
- Russian Society of Clinical Oncology, Moscow, Russia.,N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia
| |
Collapse
|
13
|
Miyazaki K, Sato S, Kodama T, Numata T, Endo T, Yamamoto Y, Shimizu K, Yamada H, Hayashihara K, Okauchi S, Satoh H, Yamada Y, Tamura T, Saito K, Kikuchi N, Kurishima K, Ishikawa H, Watanabe H, Shiozawa T, Hizawa N, Funayama Y, Hayashi S, Nakamura H, Yamashita T. Clinicopathological Features in Elderly ALK-rearranged Non-small Cell Lung Cancer Patients. In Vivo 2020; 34:2001-2007. [PMID: 32606173 DOI: 10.21873/invivo.11998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 11/10/2022]
Abstract
AIM To clarify the clinicopathological features in elderly anaplastic lymphoma kinase (ALK) rearranged non-small cell lung cancer (NSCLC) patients. PATIENTS AND METHODS A retrospective study was performed in 129 ALK rearranged NSCLC patients diagnosed between April 2008 and March 2019 in fifteen Institutions of the Ibaraki prefecture, Japan. RESULTS Median age of patients was 63 years. In 59 patients aged 65 and older, the proportions of patients with advanced stage and those treated with ALK-tyrosine kinase inhibitor (TKI) were lower than those younger than 65 years. There was no difference in overall survival (OS) between the two age groups. Among the elderly patients, no difference was observed in OS between the patients aged 65-69 and those aged 70 and older. In 89 patients treated with TKI, no significant differences were observed in the progression-free survival of TKIs and OS between patients aged 65 and older and those younger than 65, respectively. CONCLUSION Evaluation of ALK gene status and TKI treatment are desirable even for elderly patients.
Collapse
Affiliation(s)
- Kunihiko Miyazaki
- Division of Respiratory Medicine, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | - Shinya Sato
- Division of Respiratory Medicine, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | - Takahide Kodama
- Division of Respiratory Medicine, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | - Takeshi Numata
- Division of Respiratory Medicine, Mito Medical Center, Mito, Japan
| | - Takeo Endo
- Division of Respiratory Medicine, Mito Medical Center, Mito, Japan
| | - Yusuke Yamamoto
- Division of Respiratory Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Kei Shimizu
- Division of Respiratory Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Hideyasu Yamada
- Division of Respiratory Medicine, Hitachinaka General Hospital-Hitachinaka Medical Center, University of Tsukuba, Hitachinaka, Japan
| | - Kenji Hayashihara
- Division of Respiratory Medicine, Ibarakihigashi Hospital, Tokai, Japan
| | - Shinichiro Okauchi
- Divisions of Respiratory Medicine and Thoracic Surgery, Mito Kyodo General Hospital-Mito Medical Center, University of Tsukuba, Mito, Japan
| | - Hiroaki Satoh
- Divisions of Respiratory Medicine and Thoracic Surgery, Mito Kyodo General Hospital-Mito Medical Center, University of Tsukuba, Mito, Japan
| | - Yutaka Yamada
- Respiratory Center, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Tomohiro Tamura
- Respiratory Center, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Kazuto Saito
- Division of Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Norihiro Kikuchi
- Division of Respiratory Medicine, Kasumigaura Medical Center Hospital, Tsuchiura, Japan
| | - Koichi Kurishima
- Division of Respiratory Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Hiroichi Ishikawa
- Division of Respiratory Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Hiroko Watanabe
- Division of Respiratory Medicine, Tsukuba Kinen Hospital, Tsukuba, Japan
| | | | - Nobuyuki Hizawa
- Faculty of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasunori Funayama
- Division of Respiratory Medicine Tsukuba, Gakuen General Hospital, Tsukuba, Japan
| | - Shigen Hayashi
- Division of Respiratory Medicine, Ibaraki Seinan Medical Center Hospital, Sakai, Japan
| | - Hiroyuki Nakamura
- Division of Respiratory Medicine, Tokyo Medical University, Ibaraki Medical Center, Ami-machi, Japan
| | - Takaaki Yamashita
- Division of Respiratory Medicine, JA Toride Medical Center Hospital, Toride, Japan
| |
Collapse
|
14
|
Gobbini E, Chiari R, Pizzutillo P, Bordi P, Ghilardi L, Pilotto S, Osman G, Cappuzzo F, Cecere F, Riccardi F, Scotti V, Martelli O, Borra G, Maiello E, Rossi A, Graziano P, Gregorc V, Casartelli C, Sergi C, Del Conte A, Delmonte A, Bareggi C, Cortinovis D, Rizzo P, Tabbò F, Rossi G, Bria E, Galetta D, Tiseo M, Di Maio M, Novello S. Real-world outcomes according to treatment strategies in ALK-rearranged non-small-cell lung cancer (NSCLC) patients: an Italian retrospective study. Clin Transl Oncol 2019; 22:294-301. [PMID: 31630357 DOI: 10.1007/s12094-019-02222-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Anaplastic lymphoma kinase (ALK) rearrangement confers sensitivity to ALK inhibitors (ALKis) in non-small-cell lung cancer (NSCLC). Although several drugs provided an impressive outcome benefit, the most effective sequential strategy is still unknown. We describe outcomes of real-life patients according to the treatment strategy received. PATIENTS We retrospectively collected 290 ALK rearranged advanced NSCLC diagnosed between 2011 and 2017 in 23 Italian institutions. RESULTS After a median follow-up of 26 months, PFS for crizotinib and a new generation ALKis were 9.4 [CI 95% 7.9-11.2] and 11.1 months [CI 95% 9.2-13.8], respectively, while TTF were 10.2 [CI 95% 8.5-12.6] and 11.9 months [CI 95% 9.7-17.4], respectively, being consistent across the different settings. The composed outcomes (the sum of PFS or TTF) in patients treated with crizotinib followed by a new generation ALKis were 27.8 months [CI 95% 24.3-33.7] in PFS and 30.4 months [CI 95% 24.7-34.9] in TTF. The median OS from the diagnosis of advanced disease was 39 months [CI 95% 31.8-54.5]. Patients receiving crizotinib followed by a new generation ALKis showed a higher median OS [57 months (CI 95% 42.0-73.8)] compared to those that did not receive crizotinib [38 months (CI 95% 18.6-NR)] and those who performed only crizotinib as target agent [15 months (CI 95% 11.3-34.0)] (P < 0.0001). CONCLUSION The sequential administration of crizotinib and a new generation ALKis provided a remarkable clinical benefit in this real-life population, being an interesting option to consider in selected patients.
Collapse
Affiliation(s)
- E Gobbini
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy. .,Cancer Research Center Lyon, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon Cedex 08, France.
| | - R Chiari
- Oncology Unit, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 6156, Perugia, Italy
| | - P Pizzutillo
- Medical Thoracic Unit, IRCCS Istituto Oncologico "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, Italy
| | - P Bordi
- Medical Oncology Unit, University Hospital, Via Gramsci 14, 43123, Parma, Italy
| | - L Ghilardi
- Oncology Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - S Pilotto
- Oncology Unit, Department of Medicine, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - G Osman
- UOSD Pneumologia Oncologica, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Roma, Italy
| | - F Cappuzzo
- Oncology and Hematology Department, AUSL Romagna-Ravenna, Viale Randi 5, 48100, Ravenna, Italy
| | - F Cecere
- Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Roma, Italy
| | - F Riccardi
- Oncology Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli 9, 80131, Napoli, Italy
| | - V Scotti
- Radiotherapy Unit, University Hospital Careggi, Largo Brambilla 3, 50134, Firenze, Italy
| | - O Martelli
- Medical Oncology Unit, San Giovanni Addolorata Hospital, Via dell'Amba Aradam 9, 00184, Rome, Italy
| | - G Borra
- Oncology Unit, East Piedmont University, Maggiore della Carità Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - E Maiello
- Department of Oncology and Hematology, Foundation IRCCS 'Casa Sollievo della Sofferenza', Viale Cappuccini 1, 71013, San Giovanni Rotondo, Italy
| | - A Rossi
- Department of Oncology and Hematology, Foundation IRCCS 'Casa Sollievo della Sofferenza', Viale Cappuccini 1, 71013, San Giovanni Rotondo, Italy
| | - P Graziano
- Department of Oncology and Hematology, Foundation IRCCS 'Casa Sollievo della Sofferenza', Viale Cappuccini 1, 71013, San Giovanni Rotondo, Italy
| | - V Gregorc
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Hospital, Via Olgettina Milano 60, 20132, Milano, Italy
| | - C Casartelli
- Oncology Unit, Valduce Hospital, Via Dante Alighieri 11, 22100, Como, Italy
| | - C Sergi
- Oncology Unit, A.O.R.N.A.S Garibaldi Nesima, Via Palermo 636, 95100, Catania, Italy
| | - A Del Conte
- S.O.C. Oncologia Medica e dei Tumori Immunocorrelati, Centro di Riferimento Oncologico (CRO), IRCCS, Via Gallini 2, Aviano, Italy
| | - A Delmonte
- Thoracic Oncology Group, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Via Maroncelli 40, 47014, Meldola, Italy
| | - C Bareggi
- Oncology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - D Cortinovis
- Oncology Unit, ASST San Gerardo Hospital, Via G. B. Pergolesi 33, 20052, Monza, Italy
| | - P Rizzo
- Medical Oncology Division and Breast Unit, Antonio Perrino Hospital, Strada Statale 7 per Mesagne, 72100, Brindisi, Italy
| | - F Tabbò
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy
| | - G Rossi
- Operative Unit of Pathologic Anatomy, Azienda Unità Sanitaria Locale della Romagna, Hospital St. Maria delle Croci, Viale Vincenzo Randi 5, 48121, Ravenna, Italy
| | - E Bria
- U.O.C. Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Roma, Italy
| | - D Galetta
- Medical Thoracic Unit, IRCCS Istituto Oncologico "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, Italy
| | - M Tiseo
- Medical Oncology Unit, University Hospital, Via Gramsci 14, 43123, Parma, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, Mauriziano Umberto I, Via Magellano 1, 10128, Turin, Italy
| | - S Novello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy
| |
Collapse
|
15
|
Lin CC, Arkenau HT, Lu S, Sachdev J, de Castro Carpeño J, Mita M, Dziadziuszko R, Su WC, Bobilev D, Hughes L, Chan J, Zhang ZY, Weiss GJ. A phase 1, open-label, dose-escalation trial of oral TSR-011 in patients with advanced solid tumours and lymphomas. Br J Cancer 2019; 121:131-138. [PMID: 31217479 PMCID: PMC6738096 DOI: 10.1038/s41416-019-0503-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/14/2019] [Accepted: 05/21/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Anaplastic lymphoma kinase (ALK) gene rearrangements are oncogenic drivers in non-small-cell lung cancer (NSCLC). TSR-011 is a dual ALK and tropomyosin-related kinase (TRK) inhibitor, active against ALK inhibitor resistant tumours in preclinical studies. Here, we report the safety, tolerability and recommended phase 2 dose (RP2D) of TSR-011 in patients with relapsed or refractory ALK- and TRK-positive advanced cancers. METHODS In this sequential, open-label, phase 1 trial (NCT02048488), patients received doses of 30 mg, escalated to 480 mg every 24 hours (Q24h), followed by an expansion cohort of patients with ALK-positive cancers. The primary objective was to evaluate safety and tolerability. Secondary objectives included pharmacokinetics. RESULTS TSR-011 320- and 480-mg Q24h doses exceeded the maximum tolerated dose. At the RP2D of 40 mg every 8 hours (Q8h), the most common grade 3-4 treatment-emergent adverse events occurred in 3.2-6.5% of patients. Of 14 ALK inhibitor-naive patients with ALK-positive NSCLC, 6 experienced partial responses and 8 had stable disease. CONCLUSIONS At the RP2D (40 mg Q8h), TSR-011 demonstrated a favourable safety profile with acceptable QTc changes. Limited clinical activity was observed. Based on the competitive ALK inhibitor landscape and benefit/risk considerations, further TSR-011 development was discontinued. CLINICAL TRIAL REGISTRATION NUMBER NCT02048488.
Collapse
Affiliation(s)
- Chia-Chi Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hendrik-Tobias Arkenau
- Department of Medical Oncology, Sarah Cannon Research Institute and University College London, London, UK
| | - Sharon Lu
- Department of Clinical Science, TESARO: A GSK Company, Waltham, MA, USA
| | - Jasgit Sachdev
- Department of Hematology and Oncology, HonorHealth Research Institute, Scottsdale, AZ, USA
| | | | - Monica Mita
- Department of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rafal Dziadziuszko
- Department of Oncology and Radiotherapy, Uniwersyteckie Centrum Kliniczne, Gdansk, Poland
| | - Wu-Chou Su
- Department of Hematology and Oncology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Dmitri Bobilev
- Department of Clinical Science, TESARO: A GSK Company, Waltham, MA, USA
| | - Lorraine Hughes
- Department of Clinical Science, TESARO: A GSK Company, Waltham, MA, USA
| | - Jian Chan
- Department of Clinical Science, TESARO: A GSK Company, Waltham, MA, USA
| | - Zhi-Yi Zhang
- Department of Clinical Science, TESARO: A GSK Company, Waltham, MA, USA
| | - Glen J Weiss
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
16
|
Ueno N, Banno S, Endo Y, Tamura M, Sugaya K, Hashigaki S, Ohki E, Yoshimura A, Gemma A. Treatment status and safety of crizotinib in 2028 Japanese patients with ALK-positive NSCLC in clinical settings. Jpn J Clin Oncol 2019; 49:676-686. [DOI: 10.1093/jjco/hyz049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/09/2019] [Indexed: 12/12/2022] Open
Abstract
AbstractObjectivePost-marketing surveillance (PMS) was performed in Japan to obtain information on the safety and efficacy of crizotinib.MethodsTarget patients included almost all patients with anaplastic lymphoma kinase-positive non-small cell lung cancer who were administered crizotinib. The observation period was 52 weeks. In the present study, we focused on the treatment status and safety of crizotinib therapy and analyzed the real-world data obtained by this PMS (ClinicalTrials.gov: NCT01597258).ResultsThe safety analysis set included 2028 Japanese patients, and more than half of the patients (56.4%) were nonsmokers. The incidence of adverse drug reactions (ADRs) was 91.6%, and common ADRs (incidence ≥15%) were nausea (32.2%), diarrhea (24.3%), photopsia (18.9%), vomiting (17.5%) and dysgeusia (16.8%). Many patients (623 patients) discontinued treatment of crizotinib because of adverse events within 12 weeks after therapy initiation, which tended to frequently occur in the following cases: (1) elderly, (2) body weight <40 kg, (3) body surface area <1.2 m2 (4) ECOG PS 2–4, (5) higher Brinkman index and (6) history of occupational/environmental exposure such as asbestos/pneumoconiosis. The proportions of patients remaining on crizotinib therapy were 68.2% for 3 months, 55.2% for 6 months and 36.1% for 12 months, with a median duration of 7.9 months. Multivariate analysis with a Cox proportional hazard model identified 10 statistically significant patient background factors influencing the duration of crizotinib therapy.ConclusionsNo new safety concerns were observed in this PMS study. Our results provide useful information regarding the status of crizotinib therapy in the clinical setting.
Collapse
Affiliation(s)
- Naomi Ueno
- Pfizer Japan Inc, 3-22-7 Yoyogi, Shibuya-ku
| | | | | | | | | | | | - Emiko Ohki
- Pfizer Japan Inc, 3-22-7 Yoyogi, Shibuya-ku
| | | | - Akihiko Gemma
- Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
17
|
Davies J, Martinec M, Coudert M, Delmar P, Crane G. Real-world anaplastic lymphoma kinase (ALK) rearrangement testing patterns, treatment sequences, and survival of ALK inhibitor-treated patients. Curr Med Res Opin 2019; 35:535-542. [PMID: 30296185 DOI: 10.1080/03007995.2018.1533458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The anaplastic lymphoma kinase (ALK) treatment landscape is crowded following recent ALK inhibitor approvals, and updated information on real-world treatment patterns in advanced non-small-cell lung cancer (aNSCLC) with ALK rearrangement (ALK+) is needed. METHODS This retrospective US cohort study used Flatiron Health's longitudinal electronic health record (EHR)-derived database. Patients (≥ 18 years old) diagnosed with stage IIIB/IV aNSCLC, with documented ALK rearrangement and ≥2 visits after January 1, 2011 were followed until February 28, 2016. Patients enrolled on a clinical trial or exposed to ALK inhibitors other than crizotinib or ceritinib were excluded. Treatment patterns, time and type of biomarker testing, and overall survival (OS) were analyzed. RESULTS Median age (n = 300) was 62.5 years; 55% female; 48% non-smokers; 8.7% central nervous system (CNS) metastases at diagnosis. Overall, 73% and 86% received their first ALK biomarker test before/at diagnosis, or before/during first-line treatment, respectively. In total, 90.0%, 78.1%, and 74.7% received first-, second-, and third-line therapy, respectively. Most patients received ALK-targeted treatment; 62% received crizotinib, of which 21% reported a dose reduction. Progression was the most common reason for crizotinib (78%) and ceritinib (41%) discontinuation. Median OS was 29.4 months (95% CI =24.7-39.6) overall; 27.1 months (95% CI =22.0-35.0) in patients with CNS metastases, and 36.9 months (95% CI =25.1-not reached) without. CONCLUSIONS Despite widespread crizotinib use in patients with ALK+ aNSCLC, a high proportion of patients progressed. Ongoing analyses of EHR-derived cohorts are valuable in assessing real-world testing rates and therapeutic use of ALK inhibitors.
Collapse
Affiliation(s)
| | | | - Mathieu Coudert
- c F. Hoffmann-La Roche Ltd , Boulogne-Billancourt Cedex , France
| | - Paul Delmar
- b F. Hoffmann-La Roche AG Ltd , Basel , Switzerland
| | | |
Collapse
|