Three-Year Overall Survival of Advanced Stage ALK-Positive NSCLC at a Single Clinical Setting in Indonesia

Abstract

Background: ALK-positive Non-Small Cell Lung Cancer (NSCLC) is a rare condition predominantly observed in much younger non-smokers with adenocarcinoma histology, often accompanied by brain metastases. Despite its unique features, there is a lack of data concerning the treatment of ALK-positive NSCLC in Indonesia. Therefore, this study represented the first attempt to document the treatment landscape for ALK-positive NSCLC in the country. The available ALK inhibitors included crizotinib, alectinib, brigatinib, and lorlatinib, and none of these were listed under the Indonesian Universal Health Coverage as of September 2022. This study aimed to characterize survival outcomes of ALK-positive NSCLC patients treated within a specialized thoracic oncology practice in Indonesia.Methods: The retrospective observational cohort study drew secondary data from medical records of ALK-positive NSCLC patients treated at a private thoracic oncology clinic. Data were collected retrospectively, spanning from December 2019 to December 31, 2022. Exclusion criteria included incomplete data, untreated ALK-positive NSCLC, cases at stage I-III, or diagnoses made after August 2021. The observation period extended up to 36 months, although several patients exceeded 48 months, with one individual currently boasting a 96-month survival.Results: A total of 15 patients with ALK-positive NSCLC were selected as the respondents in this study. The median age stood at 50.8 years, predominantly female, and diagnosed with adenocarcinoma. Predominant sites of metastasis included pleural effusion and brain metastases, and preliminary 36-month survival rates reached 73.3%. The 1-year survival rate was recorded at 100%, while the 2-year overall survival (OS) stood at 80%, aligning closely with global ALK inhibitors clinical trial data.Conclusions: This study provided the first-ever dataset indicating an ALK-positive profile within a singular thoracic oncology clinic in Indonesia. Despite the accessibility constraints of treatments, ALK-positive patients showed comparable total survival to pivotal clinical trial data. This preliminary dataset shed light on the profile and treatment of ALK-positive NSCLC in the country.