Real-world treatment and prognostic factors for survival in ALK+ non-small cell lung cancer (NSCLC) patients with brain metastases in China.

Abstract

To explore the efficacy and prognostic factors of different treatment modalities on anaplastic lymphoma kinase (ALK)+ non-small cell lung cancer (NSCLC) patients with brain metastases (BMs). A total of 86 patients were enrolled into the study. They were divided into two cohorts based on their history of treatment with ALK tyrosine kinase inhibitors (ALK-TKIs) prior to the incidence of BMs. ALK-TKI-naïve patients with BMs were included in cohort 1 (n= 59); patients who developed BMs after ALK-TKIs treatment were enrolled in cohort 2 (n= 27). Prognostic factors related with overall survival (OS) when treated with ALK-TKIs were assessed in multivariable analysis. With a median follow-up of 41.8months, the median OS was 34.8months. In cohort 1, the OS, intracranial progression-free survival (iPFS), and progression-free survival (PFS) were 38.7months (95% CI: 23.3 to 54.1), 18.5months (95% CI: 9.6 to 27.4), and 19.1months (95% CI: 13.7 to 24.5), respectively. Significantly improved OS and iPFS were noted in those patients in which second-generation ALK-TKIs versus crizotinib were initiated (OS: not reached vs. 29.0 months, p= 0.040; iPFS: 22.8 vs. 11.9 months, p= 0.035). In cohort 2, patients who experienced BMs as a result of the treatment failure of ALK-TKIs had a median OS of 27.1months. Considerable duration of stable disease in patients with measurable BMs was observed (iPFS: 11.5months, 95% CI: 4.4 to 18.6; PFS: 12.2months, 95% CI: 3.2 to 21.1). Second-generation ALK-TKIs further improved the duration of intracranial response and survival in ALK+ NSCLC patients with BMs in a real-world setting. The potent intracranial efficacy of second-generation ALK-TKIs might generate the lowered urgency of local treatment.