Platinum/pemetrexed-based chemotherapy modestly effective for ALK+ NSCLC

  • J Thorac Oncol

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Platinum/pemetrexed-based chemotherapy yielded modest efficacy in patients with anaplastic lymphoma kinase (ALK)-positive NSCLC refractory to ≥1 second-generation ALK tyrosine kinase inhibitors (TKIs).
  • The efficacy was better in patients who received the combination chemotherapy with an ALK TKI.

Why this matters

  • The most effective next-line therapy after failure of a second-generation ALK TKI is unknown.

Study design

  • 58 patients with advanced ALK-positive NSCLC refractory to ≥1 second-generation ALK TKI(s) received platinum/pemetrexed-based chemotherapy (PT/pem-based chemotherapy).
  • Funding: National Cancer Institute and others.

Key results

  • 88% of patients had ≥2 prior ALK TKIs, and 21% had ≥3 prior ALK TKIs.
  • 95% received PT/pem-based chemotherapy immediately following a second-generation ALK inhibitor.
  • Objective response rate (ORR) was 29.7% (95% CI, 15.9%-47.0%) and central nervous system ORR was 15.8% (95% CI, 3.4%-39.6%).
  • Median overall PFS on PT/pem-based chemotherapy for the entire cohort was 4.3 (95% CI, 2.9-5.8) months.
  • Risk of intracranial progression at 1 year was 30% (95% CI, 18%-44%).
  • Receipt of any PT/pem-based combination chemotherapy plus an ALK TKI was associated with significantly better median PFS compared with PT/pem-based chemotherapy alone (7.7 vs 3.6 months; HR, 0.31; P=.002).

Limitations

  • Retrospective study.