Overall survival with crizotinib and next-generation ALK inhibitors in ALK-positive non-small-cell lung cancer (IFCT-1302 CLINALK): a French nationwide cohort retrospective study
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Michaël Duruisseaux1, Benjamin Besse2, Jacques Cadranel3, Maurice Pérol4, Bertrand Mennecier5, Laurence Bigay-Game6, Renaud Descourt7, Eric Dansin8, Clarisse Audigier-Valette9, Lionel Moreau10, José Hureaux11, Remi Veillon12, Josiane Otto13, Anne Madroszyk-Flandin14, Alexis Cortot15, François Guichard16, Pascaline Boudou-Rouquette17, Alexandra Langlais18, Pascale Missy19, Franck Morin19, Denis Moro-Sibilot1
1Centre Hospitalier Universitaire Grenoble Alpes, Thoracic Oncology Unit, Chest Department, Grenoble, France
2Medical Oncology Department, Gustave Roussy, Villejuif, France
3Assistance Publique Hôpitaux de Paris, Tenon Hospital, Chest Department, Paris, France
4Léon-Bérard Cancer Center, Lyon, France
5Centre Hospitalier Universitaire de Strasbourg, Chest Department, Strasbourg, France
6Larrey Hospital, Chest Department, Toulouse, France
7Centre Hospitalier Universitaire de Brest, Brest, France
8Oscar Lambret Cancer Center, Medical Oncology Department, Lille, France
9Centre Hospitalier Sainte Musse, Chest Department, Toulon, France
10Centre Hospitalier Général de Colmar, Louis Pasteur Hospital, Chest Department, Colmar, France
11Centre Hospitalier Universitaire d’Angers, Chest Department, Angers, France
12Centre Hospitalier Universitaire de Bordeaux, Respiratory Disease Department, Pessac, France
13Antoine Lacassagne Cancer Center, Nice, France
14Paoli Calmettes Institute, Marseille, France
15Centre Hospitalier Universitaire de Lille, Thoracic Oncology Unit, Lille, France
16Medical Oncology Department, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
17Assistance Publique Hôpitaux de Paris, Cochin-Port Royal Hospital, Medical Oncology Department, Paris, France
18French Cooperative Thoracic Intergroup, Department of Biostatistics, Paris, France
19French Cooperative Thoracic Intergroup, Clinical Research Unit, Paris, France
Denis Moro-Sibilot, email: DMoro-Sibilot@chu-grenoble.fr
Keywords: lung cancer, ALK, crizotinib, ceritinib, alectinib
Received: September 28, 2016 Accepted: January 10, 2017 Published: February 26, 2017
Overall survival (OS) with the anaplastic lymphoma kinase (ALK) inhibitor (ALKi) crizotinib in a large population of unselected patients with ALK-positive non-small-cell lung cancer (NSCLC) is not documented. We sought to assess OS with crizotinib in unselected ALK-positive NSCLC patients and whether post-progression systemic treatments affect survival outcomes.
ALK-positive NSCLC patients receiving crizotinib in French expanded access programs or as approved drug were enrolled. We collected clinical and survival data, RECIST-defined progressive disease (PD) and post-PD systemic treatment efficacy. We performed multivariable analysis of OS from crizotinib initiation and PD under crizotinib.
At time of analysis, 209 (65.7%) of the 318 included patients had died. Median OS with crizotinib was 16.6 months. The line of crizotinib therapy did not impact survival outcomes. Of the 263 patients with PD, 105 received best supportive care, 74 subsequent drugs other than next-generation ALKi and 84 next-generation ALKi. Next-generation ALKi treatment correlated with better survival outcomes in multivariate analysis. These patients had a median post-PD survival of 25.0 months and median OS from metastatic disease diagnosis of 89.6 months.
Unselected ALK-positive NSCLC patients achieve good survival outcomes with crizotinib therapy. Next-generation ALKi may provide survival improvement after PD under crizotinib.
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