Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2020 Jun;50(6):716-725.
doi: 10.1111/imj.14435.

Screening for anaplastic lymphoma kinase (ALK) gene rearrangements in non-small-cell lung cancer in New Zealand

Mark J McKeage  1   2 , Sandar Tin Tin  3 , Prashannata Khwaounjoo  4 , Karen Sheath  5 , Amanda Dixon-McIver  6 , Daniel Ng  6 , Richard Sullivan  2 , Laird Cameron  2 , Philip Shepherd  7 , George R Laking  2 , Nicola Kingston  8 , Magreet Strauss  8 , Christopher Lewis  9 , Mark Elwood  3 , Donald R Love  5   10
Affiliations
Observational Study

Screening for anaplastic lymphoma kinase (ALK) gene rearrangements in non-small-cell lung cancer in New Zealand

Mark J McKeage et al. Intern Med J. 2020 Jun.

Abstract

Background: Lung cancer is a major cause of death in New Zealand. In recent years, targeted therapies have improved outcomes.

Aim: To determine the uptake of anaplastic lymphoma kinase (ALK) testing, and the prevalence, demographic profile and outcomes of ALK-positive non-small-cell lung cancer (NSCLC), in New Zealand, where no national ALK-testing guidelines or subsidised ALK tyrosine kinase inhibitor (TKI) therapies are available.

Methods: A population-based observational study reviewed databases to identify patients presenting with non-squamous NSCLC over 6.5 years in northern New Zealand. We report the proportion tested for ALK gene rearrangements and the results. NSCLC samples tested by fluorescence in situ hybridisation were retested by next generation sequencing and ALK immunohistochemistry. A survival analysis compared ALK-positive patients treated or not treated with ALK TKI therapy.

Results: From a total of 3130 patients diagnosed with non-squamous NSCLC, 407 (13%) were tested for ALK gene rearrangements, and patient selection was variable and inequitable. Among those tested, 34 (8.4%) had ALK-positive NSCLC. ALK-positive disease was more prevalent in younger versus older patients, non-smokers versus smokers and in Māori, Pacific or Asian ethnic groups than in New Zealand Europeans. Fluorescence in situ hybridisation, ALK immunohistochemistry and next generation sequencing showed broad concordance for detecting ALK-positive disease under local testing conditions. Among patients with ALK-positive metastatic NSCLC, those treated with ALK TKI survived markedly longer than those not treated with ALK TKI (median overall survival 5.12 vs 0.55 years).

Conclusion: Lung cancer outcomes in New Zealand may be improved by providing national guidelines and funding policy for ALK testing and access to subsidised ALK TKI therapy.

Keywords: ALK testing; anaplastic lymphoma kinase; non-small-cell lung cancer; overall survival; tyrosine kinase inhibitor.

PubMed Disclaimer

References

    1. Anonymous. Cancer New Registrations and Deaths. Wellington: Ministry of Health; 2013; 2016.
    1. Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Niksic M et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet 2018; 391: 1023-75.
    1. Elwood JM, Aye PS, Tin ST. Increasing disadvantages in cancer survival in New Zealand compared to Australia, between 2000-05 and 2006-10. Plos One 2016; 11: e0150734.
    1. Stevens W, Stevens G, Kolbe J, Cox B. Management of stages I and II non-small-cell lung cancer in a New Zealand study: divergence from international practice and recommendations. Intern Med J 2008; 38: 758-68.
    1. McKeage M, Elwood M, Tin Tin S, Khwaounjoo P, Aye P, Li A et al. EGFR mutation testing of non-squamous NSCLC: impact and uptake during implementation of testing guidelines in a population-based registry cohort from northern New Zealand. Target Oncol 2017; 12: 663-75.

Publication types

MeSH terms

Substances

LinkOut - more resources