Significance of alectinib in anaplastic lymphoma kinase-tyrosine kinase inhibitors for anaplastic lymphoma kinase-positive patients with non–small cell lung cancer

Yasuhiro Chikaishi, Kenichi Kobayashi, Hiroki Matsumiya, Akihiro Taira, Yusuke Nabe, Shinji Shinohara, Taiji Kuwata, Masaru Takenaka, Soichi Oka, Ayako Hirai, Kouji Kuroda, Naoko Imanishi, Yoshinobu Ichiki, Fumihiro Tanaka


Background: Various anaplastic lymphoma kinase-tyrosine kinase inhibitors (ALK-TKIs) have been approved for use with patients with ALK-positive non–small cell lung cancer (NSCLC). However, little is known about the use of ALK-TKI in real-world clinical settings. Herein we present data from ALK-positive patients with NSCLC at our single institution.
Methods: We retrospectively examined data from all patients who were administered ALK-TKIs for NSCLC from March 2012 until October 2018 at our institution.
Results: Eleven patients received ALK-TKIs for NSCLC. The median age was 65 years (range, 45–85 years, mean 64 years), and all patients were diagnosed with adenocarcinoma. One patient had no treatment history, and the remaining 10 patients underwent surgery upon initiation of ALK-TKIs. Initial ALK-TKIs included crizotinib (n=2) and alectinib (n=9). The median follow-up was 21 months (range, 3.5–57 months). The 4-year overall survival (OS) rate was 71.4% for all patients. All patients achieved partial response or complete response. Two patients on crizotinib and one patient on alectinib experienced adverse events. Three patients received three types of ALK-TKIs; eight patients received only one ALK-TKI. One patient developed interstitial lung disease (ILD) and underwent salvage surgery after treatment with alectinib. ALK-TKIs affected brain metastases (BM) in four of five patients.
Conclusions: Alectinib was associated with the best outcomes of available ALK-TKI medications. Alectinib is a key and approved drug. Alectinib should be administered as a first-line therapy for many patients.