Brief Report: Real-world treatment patterns and clinical outcomes for patients with advanced ALK rearranged non-small cell lung cancer (NSCLC) in British Columbia

Abstract

IntroductionEML4-ALK rearrangements represent an oncogenic driver alteration in 5% of non-small cell lung cancer (NSCLC) cases. We aim to better understand real-world treatment patterns and outcomes of ALK+ patients with advanced stage NSCLC. MethodsWe performed a retrospective population-based chart review of ALK+ patients with locally advanced or metastatic NSCLC in British Columbia (BC), Canada. Patients diagnosed from January 2014 to May 2023 were identified via the BC Cancer Genetics Laboratory database and data was collected up to December 2023. ResultsA total of 216 patients with stage IIIB/IV ALK+ lung NSCLC were identified. Median age was 60 (range 24-91), 151 (68.9%) had never smoked, and 95 (43.9%) were Asian. The median overall survival was 49.4 months with median follow-up time of 55.4 months.Most of the cohort (n=198, 91.7%) received palliative systemic therapy, all of which included at least one ALK tyrosine kinase inhibitor (TKI). The most common first-line regimen was alectinib (n=97, 49.0%) followed by crizotinib (n=84, 42.4%); only four and one patient received lorlatinib and brigatinib first-line, respectively. Alectinib was commonly prescribed overall, with 80.3% of patients receiving it in any treatment line. Time to treatment discontinuation (TTD) was significantly longer on first-line alectinib at 22.9 months as compared to 10.9 months for crizotinib. ConclusionsALK+ advanced NSCLC patients in BC have durable responses to ALK TKIs. Despite approval of all ALK TKIs for first-line use since 2021, alectinib is largely the favored agent in BC. Further real-world investigations can refine treatment strategies and shape policies around ALK TKIs for ALK+ NSCLC patients.