2023 North America Conference on Lung Cancer (NACLC) - Posters and Abstracts-PP01.065 Justin Cheung NACLC23 Abstract

PP01.065 Justin Cheung NACLC23 Abstract

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This study evaluated the efficacy and safety of dose-escalated alectinib in patients with metastatic ALK-positive non-small cell lung cancer (NSCLC) who had relapsed in the central nervous system (CNS) while on standard dose alectinib. A total of 27 patients were included in the retrospective study, and they received dose-escalated alectinib at 900 mg twice daily after experiencing CNS relapse on the standard dose of 600 mg twice daily. The median duration of dose-escalated alectinib therapy was 7.7 months.<br /><br />Results showed that the CNS disease control rate (DCR) was 92.0%, with a CNS objective response rate (ORR) of 12.0%. The median CNS duration of control was 5.3 months, and the median CNS time to progression (TTP) was 7.1 months. Overall, the disease control rate on dose-escalated alectinib was 77.8% with a median duration of disease control of 4.4 months and a median TTP of 7.1 months.<br /><br />Among the patients who experienced disease progression on dose-escalated alectinib, all had CNS progression and three had extracranial disease progression as well. Twelve patients received subsequent treatment with lorlatinib, with a median duration of lorlatinib therapy of 41.3 months, a median CNS TTP of 35.2 months, and a median overall TTP of 12.8 months.<br /><br />Dose-escalated alectinib was generally well-tolerated, with no treatment discontinuations or grade 3 or higher treatment-related adverse events. One patient required a dose reduction due to grade 2 fatigue. The majority of patients experienced grade 1-2 treatment-related adverse events.<br /><br />In conclusion, dose-intensification of alectinib proved to be effective and well-tolerated in patients with metastatic ALK-positive NSCLC who experienced CNS relapse on standard dose alectinib. It may be a viable therapeutic option for re-establishing CNS disease control. Patients who progressed on dose-escalated alectinib were able to receive subsequent treatment with lorlatinib and had durable clinical benefit.

Keywords

efficacy

safety

dose-escalated alectinib

metastatic ALK-positive non-small cell lung cancer

CNS relapse

retrospective study

CNS disease control rate

CNS objective response rate

lorlatinib therapy

therapeutic option