P1.03-010 Efficacy and Safety of Anaplastic Lymphoma Kinase (ALK) Tyrosine Kinase Inhibitors in ALK-Positive Non-Small Cell Lung Cancer

Abstract

Anaplastic lymphoma kinase (ALK) gene rearrangements occur in 3-5% of non-small cell lung cancer (NSCLC) cases. ALK tyrosine kinase inhibitors (ALK-TKIs), such as crizotinib and alectinib, are recommended for the treatment of ALK-positive NSCLC. However, acquired resistance to the ALK-TKIs develops after treatment with these agents. Therefore, it is necessary to consider the alteration of the therapeutic approach against ALK-positive NSCLC. This investigation, reviewed patients with ALK-positive NSCLC treated at Hiratsuka Kyosai Hospital in 2016, to determine the efficacy and safety of ALK-TKIs in this setting. The medical data of 11 patients who had been diagnosed with ALK-positive advanced NSCLC and treated with ALK-TKIs at Hiratsuka Kyosai Hospital in 2016 were reviewed retrospectively. A total of 11 patients (3 males and 8 females; mean age: 62 years) with ALK-positive NSCLC were investigated. All the pathological types were adenocarcinomas. Eight patients were treated with crizotinib as first-line therapy, and 3 out of those patients were treated with alectinib as second-line therapy. The remaining 3 patients were treated with alectinib as first-line therapy. The overall response rate was 87.5%, and the median progression-free survival was not reached. Four patients had developed PD while receiving crizotinib. Two out of those patients have developed brain metastasis, and were administered local radiotherapy to the brain. Patients who progressed following treatment with ALK-TKIs, were treated with pemetrexed-based chemotherapy. Although adverse events (AEs) of crizotinib were more than those of alectinib, most of them were of Grade 1 to 2 severity. Most common AEs of crizotinib included vision disorder (62.5%), diarrhea (50%), elevated aminotransferases (50%), and nausea (37.5%). Grade 3 to 4 adverse events were reported in 4 cases. However, all of them were controlled by withdrawal of treatment or reduction of dosage. ALK-TKIs demonstrate good efficacy and safety in patients with ALK-positive NSCLC.