Real-World Treatment and Outcomes of ALK-Positive Metastatic Non–Small Cell Lung Cancer in a Southeast Asian Country

Abstract

Purpose

Anaplastic lymphoma kinase (ALK) inhibitors are associated with good overall survival (OS) for ALK-positive metastatic non–small cell lung cancer (NSCLC). However, these treatments can be unavailable or limited by financial constraints in developing countries. Using data from a nationwide lung cancer registry, the present study aimed to identify treatment patterns and clinical outcomes of ALK-positive NSCLC in Malaysia.

Methods

This retrospective study examined data of patients with ALK-positive NSCLC from 18 major hospitals (public, private, or university teaching hospitals) throughout Malaysia between January 1, 2015 and December 31, 2020 from the National Cardiovascular and Thoracic Surgical Database (NCTSD). Data on baseline characteristics, treatments, radiological findings, and pathological findings were collected. Overall survival (OS) and time on treatment (TOT) were calculated using the Kaplan–Meier method.

Results

There were 1581 NSCLC patients in the NCTSD. Based on ALK gene-rearrangement test results, only 65 patients (4.1%) had ALK-positive advanced NSCLC. Of these 65 patients, 59 received standard-of-care treatment and were included in the analysis. Crizotinib was the most commonly prescribed ALK inhibitor, followed by alectinib and ceritinib. Patients on ALK inhibitors had better median OS (62 months for first-generation inhibitors, not reached at time of analysis for second-generation inhibitors) compared to chemotherapy (27 months), but this was not statistically significant (P=0.835) due to sample-size limitations. Patients who received ALK inhibitors as first-line therapy had significantly longer TOT (median of 11 months for first-generation inhibitors, not reached for second-generation inhibitors at the time of analysis) compared to chemotherapy (median of 2 months; P<0.01).

Conclusion

Patients on ALK inhibitors had longer median OS and significantly longer TOT compared to chemotherapy, suggesting long-term benefit.

Keywords:

• ALK inhibitors
• chemotherapy
• ALK-positive
• NSCLC

Acknowledgments

The authors wish to thank the Malaysian Association for Thoracic and Cardiovascular Surgery for maintaining the lung cancer database, study coordinators at each of the participating centers, and Anne John Michael for help in preparing the manuscript.

Disclosure

Professor Dr Gwo Fuang Ho reports grants and/or nonfinancial support from Eli Lily, Regeneron, MSD, AB Science, Astellas, Tessa Therapeutics, and Arcus Bioscience, grants and personal fees from Roche, Boehringer Ingelheim, and Janssen Pharmaceuticals, grants, personal fees, and nonfinancial support from AstraZeneca, Pfizer, and Ipsen, personal fees from Bristol Myers Squibb, and nonfinancial support from Taiho outside the submitted work. Dr Harissa H Hasbullah reports personal fees from MSD and AstraZeneca and grants from Novartis and Roche outside the submitted work. Dr Lye Mun Tho reports personal fees from Novartis, Pfizer, Roche, AstraZeneca, and Bristol Myers Squibb outside the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

This work was supported by the Malaysian Thoracic Society.