Department of Medical Oncology, Ege University School of Medicine, Tulay Aktas Oncology Hospital, Izmir, Turkey.
Depatment of Pathology, Ege University School of Medicine, Izmir, Turkey.
Indian J Cancer. 2022 Apr-Jun;59(2):251-256. doi: 10.4103/ijc.IJC_71_20.
Anaplastic lymphoma kinase (ALK)-rearranged nonsmall cell lung cancer (NSCLC) represents a molecular subgroup with high sensitivity to ALK inhibitors. Tyrosine kinase inhibitor crizotinib, an anticancer drug acting as an ALK inhibitor, has shown remarkable response in ALK-positive NSCLC. The aim of our study is to explore the adverse events (AEs) of patients on crizotinib therapy and analyze the predictability of AEs for better survival or response on NSCLC patients.
The medical records of our ALK-positive metastatic NSCLC patients who applied between years 2013 and 2018 had been reviewed retrospectively. ALK positivity of all patients had been detected by fluorescence in situ hybridization and no other driver mutations were present. Patient demographics, performance status, smoking history, previous treatments, metastatic sites, and AEs were recorded for further analyses.
Thirty-six ALK-positive metastatic NSCLC patients were included in the study. Median follow-up was 30.1 months. Median progression-free survival (PFS) for patients who developed hepatic, cardiac, or endocrine toxicities was similar when compared to patients who did not develop. Although there was a numeric median PFS difference between patients who did develop visual disorders (18.4 months) and did not develop visual disorders (15.5 month), this was not regarded as statistically significant. However, median PFS of the patients who developed neutropenia upon crizotinib treatment (31.9 months) was found to be more favorable than the patients with normal neutrophil counts (12.8 months) (P = 0.026).
Neutropenia under crizotinib treatment was found to be associated with improved PFS suggesting that neutropenia might be an important determinant in treatment and survival strategies.
间变性淋巴瘤激酶（ALK）重排非小细胞肺癌（NSCLC）是一种对 ALK 抑制剂高度敏感的分子亚群。ALK 抑制剂克唑替尼是一种抗癌药物，在 ALK 阳性 NSCLC 中显示出显著的反应。我们研究的目的是探讨克唑替尼治疗患者的不良事件（AE），并分析 AE 对 NSCLC 患者生存或反应的预测性。
回顾性分析了 2013 年至 2018 年间应用克唑替尼治疗的 ALK 阳性转移性 NSCLC 患者的病历。所有患者的 ALK 阳性均通过荧光原位杂交检测，且无其他驱动突变。记录患者的人口统计学、表现状态、吸烟史、既往治疗、转移部位和 AE，以便进一步分析。
本研究纳入 36 例 ALK 阳性转移性 NSCLC 患者。中位随访时间为 30.1 个月。与未发生肝、心或内分泌毒性的患者相比，发生这些毒性的患者中位无进展生存期（PFS）相似。尽管发生视觉障碍（18.4 个月）和未发生视觉障碍（15.5 个月）的患者之间存在中位 PFS 的数值差异，但这并不具有统计学意义。然而，克唑替尼治疗后发生中性粒细胞减少的患者中位 PFS（31.9 个月）明显长于中性粒细胞计数正常的患者（12.8 个月）（P=0.026）。
克唑替尼治疗时出现中性粒细胞减少与改善的 PFS 相关，提示中性粒细胞减少可能是治疗和生存策略的重要决定因素。
