Meeting
2022 ASCO Annual Meeting
Treatment patterns and outcomes in ALK or ROS1 altered NSCLC: An ATOMIC Registry Study.
Authors
Melina Elpi Marmarelis
University of Pennsylvania, Philadelphia, PA
Melina Elpi Marmarelis , Connor B. Grady , Geoffrey Liu , Devalben Patel , Stephen V. Liu , Gabriela Liliana Bravo Montenegro , Tejas Patil , Jorge J. Nieva , Amanda Herrmann , Kristen Marrone , Vincent K. Lam , Fangdi Sun , Jonathan Dowell , Vamsidhar Velcheti , Matthew Nguyen , Kelsey Leigh Miller , Wade Thomas Iams , Wei-Ting Hwang , D. Ross Camidge , Charu Aggarwal
Organizations
University of Pennsylvania, Philadelphia, PA, Penn Medicine, Philadelphia, PA, Princess Margaret Cancer Centre, Toronto, ON, Canada, Georgetown University, Department of Hematology and Oncology, School of Medicine, Washington, DC, Georgetown University, Georgetown, DC, University of Colorado Cancer Center, Aurora, CO, University of Southern California, Norris Cancer Center, Los Angeles, CA, Keck School of Medicine, Los Angeles, CA, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, Massachusetts General Hospital, Boston, MA, University of Texas Southwestern Medical Center, Dallas, TX, Cleveland Clinic Foundation, Cleveland, OH, University of Pittsburgh, Pittsburgh, PA, University of North Carolina, Chapel Hill, NC, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Chicago, IL, University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia, PA
Research Funding
Pharmaceutical/Biotech Company
Other Foundation
Background: New tyrosine kinase inhibitors (TKIs) targeting ALK and ROS1 alterations in non-small cell lung cancer (NSCLC) have emerged over the last decade. Given the rarity of these genetic changes in NSCLC, data on long term outcomes with sequential therapies are limited. Methods: We conducted a multicenter retrospective cohort study of patients with metastatic NSCLC and ALK or ROS1 alterations across 12 Academic Thoracic Oncology Medical Investigators Consortium (ATOMIC) sites between 1/29/2007 and 3/31/2021. Data were abstracted from the electronic medical record. Median time to treatment discontinuation (TTD) of 1st TKI, overall survival (OS), and time to brain metastases were estimated using Kaplan-Meier methodology from start date of 1st TKI. Results: 566 patients with ALK (n = 464) or ROS1 (n = 102) were included. The majority (ALK: 426/464, 92%; ROS1: 88/102, 86%) received a TKI at some point during therapy (1st line TKI n = 262 ALK, 48 ROS1). Crizotinib was the most common 1st TKI (ALK: 57%; ROS1: 88%). Following crizotinib, alectinib (64%) and lorlatinib (41%) were the most common subsequent TKIs for ALK and ROS1, respectively. Alectinib (38%) and entrectinib (10.2%) were the 2nd most common initial TKIs used in ALK and ROS1, respectively. Additional treatment patterns presented in table. With a median follow up time of 31.1 (ALK, 95% CI, 27.6-35.0) and 32.6 (ROS1, 95% CI, 25.7-39.6) months, median OS from start of 1st TKI was 53.3 (ALK, 95% CI, 40.0-68.9) and 42.0 (ROS1, 95% CI, 31.8-NA) months. Out of the 321 patients with brain imaging prior to 1st line therapy, 40% (105/262, ALK) and 39% (23/59, ROS1) had CNS disease. Median time to development of brain metastases from start of 1st TKI in those without previous CNS disease (ALK: 278; ROS1: 58) was 30.0 (ALK, 95% CI, 25.3-39.1) and 27.0 (ROS1, 95% CI, 18.2-NA) months. Median TTD of 1st TKI was 11.2 (ALK) and 10.8 (ROS1) months. Conclusions: This is the largest retrospective cohort of NSCLC patients with ALK or ROS1 rearrangements treated in the real world setting. CNS metastases are common and subset analyses by agent and by year of diagnosis will be presented. Median time to CNS metastasis of > 2 years supports revision of the NCCN guidelines to include regular surveillance brain MRIs in this population.
| ALK 1st TKI (n) | 2nd TKI | % among those who switch to a 2nd TKI | ROS1 1st TKI (n) | 2nd TKI | % among those who switch to a 2nd TKI |
|---|---|---|---|---|---|
| Crizotinib (243) | Alectinib | 64% (121) | Crizotinib (77) | Lorlatinib | 41% (15) |
| Ceritinib | 22% (41) | Entrectinib | 24 % (9) | ||
| Brigatinib | 7% (14) | Ceritinib | 16% (6) | ||
| Alectinib (162) | Lorlatinib | 49% (17) | Entrectinib (9) | Repotrectinib | 66% (2) |
| Brigatinib | 29% (10) | Crizotinib | 33% (1) | ||
| Lorlatinib (2) | Crizotinib | (1) | |||
| Ceritinib (9) | Alectinib | 75% (6) | |||
| Crizotinib | 25% (2) |
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Abstract Details
Session Type
Poster Session
Session Title
Lung Cancer—Non-Small Cell Metastatic
Track
Lung Cancer
Sub Track
Metastatic Non–Small Cell Lung Cancer
Citation
J Clin Oncol 40, 2022 (suppl 16; abstr 9077)
DOI
10.1200/JCO.2022.40.16_suppl.9077
Abstract #
9077
Poster Bd #
64
Abstract Disclosures
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