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Soo RA, Martini JF, van der Wekken AJ, Teraoka S, Ferrara R, Shaw AT, Shepard D, Calella AM, Polli A, Toffalorio F, Tomasini P, Chiu CH, Kowalski DM, Kim HR, Solomon BJ. Early Circulating Tumor DNA Dynamics and Efficacy of Lorlatinib in Patients With Treatment-Naive, Advanced, ALK-Positive NSCLC. J Thorac Oncol 2023; 18:1568-1580. [PMID: 37295609 DOI: 10.1016/j.jtho.2023.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Circulating tumor DNA (ctDNA) has been used as a biomarker for prognostication and response to treatment. Here, we evaluate ctDNA as a potential biomarker for response to lorlatinib, a third-generation ALK tyrosine kinase inhibitor in patients with treatment-naive, advanced, ALK-positive NSCLC in the ongoing phase 3 CROWN study (NCT03052608). METHODS Molecular responses were calculated using mean variant allele frequency (VAF), longitudinal mean change in VAF (dVAF), and ratio to baseline. Efficacy assessments (progression-free survival [PFS] and objective response rate) were paired with individual patient ctDNA and analyzed for association. RESULTS Compared with baseline, mean VAF at week 4 was decreased in both treatment arms. Considering all detected somatic variants, a reduction in dVAF (≤0) was associated with a longer PFS in the lorlatinib arm. The hazard ratio (HR) for a dVAF less than or equal to 0 versus more than 0 was 0.50 (95% confidence interval [CI]: 0.23-1.12) in the lorlatinib arm. A similar association was not observed for crizotinib (HR = 1.00, 95% CI: 0.49-2.03). Comparing molecular responders with nonresponders, patients treated with lorlatinib who had a molecular response had longer PFS (HR = 0.37, 95% CI: 0.16-0.85); patients treated with crizotinib who had a molecular response had similar PFS as those without a molecular response (HR = 1.48, 95% CI: 0.67-3.30). CONCLUSIONS In patients with treatment-naive, advanced, ALK-positive NSCLC, early ctDNA dynamics predicted better outcome with lorlatinib but not with crizotinib. These results suggest that ctDNA may be used to monitor and potentially predict efficacy of lorlatinib treatment.
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Affiliation(s)
- Ross A Soo
- Department of Hematology-Oncology, National University Cancer Institute, Singapore, Singapore.
| | | | - Anthonie J van der Wekken
- Department of Pulmonology, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands
| | - Shunsuke Teraoka
- Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | - Roberto Ferrara
- Department of Medical Oncology, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Alice T Shaw
- Center for Thoracic Cancers, Massachusetts General Hospital, Boston, Massachusetts
| | - Deborah Shepard
- Global Product Development-Oncology & Rare Disease, Pfizer, La Jolla, California
| | - Anna Maria Calella
- Global Product Development-Oncology & Rare Disease, Pfizer, Milan, Italy
| | - Anna Polli
- Global Product Development-Oncology & Rare Disease, Pfizer, Milan, Italy
| | | | - Pascale Tomasini
- Multidisciplinary Oncology and Therapeutic Innovations Department, Marseille University, Marseille, France
| | - Chao-Hua Chiu
- Division of Pulmonary Medicine, Taipei Cancer Center and Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Dariusz M Kowalski
- Department of Lung Cancer and Chest Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Hye Ryun Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Benjamin J Solomon
- Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Soo RA, Huat Tan E, Hayashi H, Seto T, Lin C, Ignatius Ou S, Kim D, Liu G, Abbattista A, Martini J, Hooi Wong C, Toffalorio F, Solomon BJ. Efficacy and safety of lorlatinib in Asian and non-Asian patients with ALK-positive advanced non-small cell lung cancer: Subgroup analysis of a global phase 2 trial. Lung Cancer 2022. [DOI: 10.1016/j.lungcan.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/06/2022] [Accepted: 05/22/2022] [Indexed: 11/23/2022]
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