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
. 2023 Jan 13:15:31-41.
doi: 10.2147/CMAR.S393729. eCollection 2023.

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

Mau Ern Poh  1 , Soon Hin How  2   3 , Gwo Fuang Ho  4 , Yong Kek Pang  1 , Harissa H Hasbullah  5   6 , Lye Mun Tho  7 , Ibtisam Muhamad Nor  6 , Bee Chiu Lim  3 , Kean Fatt Ho  8 , Muthukkumaran Thiagarajan  6 , Azlina Samsudin  9 , Azza Omar  10 , Choo Khoon Ong  11 , Sing Yang Soon  12 , Justin Yu Kuan Tan  9 , Muhammad Adil Zainal Abidin  2
Affiliations

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

Mau Ern Poh et al. Cancer Manag Res. .

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; ALK-positive; NSCLC; chemotherapy.

PubMed Disclaimer

Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Kaplan–Meier OS curves for chemotherapy and first- and second-generation ALK inhibitors.
Figure 2
Figure 2
Kaplan–Meier OS curves for chemotherapy and specific ALK inhibitors.
Figure 3
Figure 3
Kaplan–Meier OS curves by number of ALK-inhibitor lines.
Figure 4
Figure 4
Kaplan–Meier curves for time on treatment.
See this image and copyright information in PMC

References

    1. Lee VHF, Mok TSK, Goto Y., et al. Differences between the east and the west in managing advanced-stage non-small cell lung cancer. Clin Oncol. 2020;32(1):e1–e9. doi:10.1016/j.clon.2019.07.014 - DOI - PubMed
    1. Soda M, Choi YL, Enomoto M, et al. Identification of the transforming EML4-ALK fusion gene in non-small-cell lung cancer. Nature. 2007;448(7153):561–566. doi:10.1038/nature05945 - DOI - PubMed
    1. Koivunen JP, Mermel C, Zejnullahu K, et al. EML4-ALK fusion gene and efficacy of an ALK kinase inhibitor in lung cancer. Clin Cancer Res. 2008;14(13):4275–4283. doi:10.1158/1078-0432.CCR-08-0168 - DOI - PMC - PubMed
    1. Chiarle R, Voena C, Ambrogio C, Piva R, Inghirami G. The anaplastic lymphoma kinase in the pathogenesis of cancer. Nat Rev Cancer. 2008;8(1):11–23. doi:10.1038/nrc2291 - DOI - PubMed
    1. Shaw AT, Engelman JA. ALK in lung cancer: past, present, and future. J Clin Oncol. 2013;31(8):1105–1111. doi:10.1200/JCO.2012.44.5353 - DOI - PMC - PubMed