Chazan Grace, Franchini Fanny, Shah Roma, Alexander Marliese, John Ani, IJzerman Maarten, Solomon Benjamin
Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.
Cancer Health Services Research, Centre for Cancer Research and Centre for Health Policy, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
JTO Clin Res Rep. 2024 Mar 7;5(8):100662. doi: 10.1016/j.jtocrr.2024.100662. eCollection 2024 Aug.
rearranged advanced NSCLC (aNSCLC) represents 4% of all NSCLCs, and multiple ALK-targeted therapies (ALK-inhibitors) are now available for use. Little is known about changes in treatment patterns, or how prognostic factors and sequence of therapy may impact overall survival in the real-world setting. We aim to describe initial and subsequent treatments used, survival outcomes, prognostic factors, and the impact of treatment on overall survival in the largest (N = 739) real-world cohort of patients with ALK+ aNSCLC reported in the literature.
Retrospective observational cohort study with data drawn from a U.S.-based electronic health record-derived, deidentified database. Eligible patients were diagnosed with ALK+ aNSCLC between 2011-2020 and were treated in multiple different cancer clinics and across multiple geographic regions throughout the United States.
From a cohort of 63,667 patients with aNSCLC, 739 patients with ALK+ NSCLC were eligible for analysis, median age was 63 years, 54% patients were female, and 85% were managed in community setting. More than 168 different treatment sequences were observed, and treatment utilization changed over time. Cohort median overall survival was 37 months (95% confidence interval: 33-45). Positive prognostic factors were as follows: never-smoking history, younger age, treatment in an academic setting, and initial early stage at diagnosis. Initial treatment with a second-generation ALK-inhibitor was associated with improved survival compared with chemotherapy.
For people with ALK+ aNSCLC, this study has identified several important clinical prognostic factors and is practice affirming; first-line treatment with a second-generation ALK-inhibitor improves survival compared with chemotherapy.
重排型晚期非小细胞肺癌（aNSCLC）占所有非小细胞肺癌的4%，目前有多种ALK靶向治疗药物（ALK抑制剂）可供使用。对于治疗模式的变化，或者预后因素和治疗顺序如何在现实环境中影响总生存期，我们知之甚少。我们旨在描述在文献报道的最大规模（N = 739）的ALK阳性aNSCLC患者真实世界队列中使用的初始和后续治疗、生存结果、预后因素以及治疗对总生存期的影响。
采用回顾性观察性队列研究，数据来自美国基于电子健康记录的去识别数据库。符合条件的患者在2011年至2020年间被诊断为ALK阳性aNSCLC，并在美国多个不同的癌症诊所和多个地理区域接受治疗。
在63667例aNSCLC患者队列中，739例ALK阳性NSCLC患者符合分析条件，中位年龄为63岁，54%为女性，85%在社区环境中接受治疗。观察到超过168种不同的治疗顺序，治疗利用率随时间变化。队列中位总生存期为37个月（95%置信区间：33 - 45）。阳性预后因素如下：无吸烟史、年龄较轻、在学术环境中治疗以及诊断时初始为早期阶段。与化疗相比，初始使用第二代ALK抑制剂治疗与生存期改善相关。
对于ALK阳性aNSCLC患者，本研究确定了几个重要的临床预后因素，并且肯定了临床实践；与化疗相比，第二代ALK抑制剂一线治疗可改善生存期。
