Taiwan Nationwide Study of First-Line ALK-TKI Therapy in ALK-Positive Lung Adenocarcinoma.
Journal
Targeted oncology
Journal Volume
19
Journal Issue
6
Start Page
941
End Page
955
ISSN
1776-260X
Date Issued
2024-11
Author(s)
Zheng, Zhe-Rong
Wu, Jia-Jun
Chen, Tzu-I
Chen, Kun-Chieh
Chu, Cheng-Hsiang
Lin, Sheng-Yi
Liu, Tsang-Wu
Chang, Gee-Chen
DOI
10.1007/s11523-024-01104-6
Abstract
Background: The clinical outcomes of patients with anaplastic lymphoma kinase-positive (ALK+) advanced lung adenocarcinoma vary according to real-world data. Objective: In this study, we aimed to investigate the treatment discontinuation (TTD) and overall survival (OS) of patients with ALK+ advanced lung adenocarcinoma treated with first-line ALK–TKIs in Taiwan. Patients and Methods: This retrospective study evaluated all advanced lung adenocarcinoma patients registered in the National Taiwan Cancer Registry from 2017 to 2020 who had ALK rearrangement and received ALK–TKI treatment, using data from Taiwan’s National Health Insurance Research Database (NHIRD). The TKI treatment sequences were classified into first generation (G1: crizotinib), second generation (G2: ceritinib, alectinib, brigatinib), and third generation (G3: lorlatinib). Results: A total of 587 patients were analyzed, with a median age of 60.0 years, 91 (15.5%) aged ≥ 74 years, 293 (49.9%) female, 397 (67.6%) never smoked, and 534 (91.0%) with stage IV disease. Patients who received next-generation ALK–TKIs during the treatment course had longer median time to ALK–TKI TTD and OS. The TTD of the G1, G1+2, G1+2+3, G2, and G2+3 groups was 7.5 (5.4–11.1), 40.6 (29.4–not calculated (NC)), 50.3 (41.3–NC), 34.3 (29.2–43.0), and 36.3 (22.4–NC) months, respectively (p < 0.001). The median OS of the patients in the G1, G1+2, G1+2+3, G2, and G2+3 groups was 10.6 (7.5–14.6), not reached (NR) (NC–NC), NR (NC–NC), 43.0 (36.3–NC), and NR (30.3–NC) months, respectively (p < 0.001). Compared with treatment with crizotinib alone, the multivariate analysis revealed that treatment with next-generation TKIs was independently associated with longer TTD (G1+2 (hazard ratio (HR), 0.24; 95% CI 0.17–0.33; p < 0.001), G1+2+3 or G1+3 (HR, 0.17; 95% confidence interval (CI), 0.10–0.28; p < 0.001), G2 (HR, 0.26; 95% CI 0.19–0.36; p < 0.001), and G2+3 (HR, 0.25; 95% CI 0.14–0.44; p < 0.001)) and median OS (G12 (HR, 0.24; 95% CI 0.17–0.35; p < 0.001), G1+2+3 or G1+3 (HR, 0.09; 95% CI 0.04–0.21; p < 0.001), G2 (HR, 0.22; 95% CI 0.15–0.31; p < 0.001), and G2+3 (HR, 0.20; 95% CI 0.10–0.42; p < 0.001)). Conclusions: For patients with ALK+ NSCLC, treatments including next-generation ALK–TKIs were independently associated with longer survival outcomes.
SDGs
Type
journal article