2024 World Conference on Lung Cancer (WCLC) - ePosters-EP.12B.10 Patterns and Clinical Impact of Alectinib Dose Reduction in Patients with ALK-Positive Non- Small Cell Lung Cancer (NSCLC)

EP.12B.10 Patterns and Clinical Impact of Alectinib Dose Reduction in Patients with ALK-Positive Non- Small Cell Lung Cancer (NSCLC)

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This study investigates the effects of dose reduction of the second-generation ALK inhibitor, alectinib, in patients with ALK-positive non-small cell lung cancer (NSCLC). ALK rearrangement, common in young, non-smoking patients, often leads to CNS metastases. Alectinib, noted for its CNS efficacy, is a standard treatment, albeit with adverse events prompting dose reductions. The ALEX trial indicated a 16% dose reduction due to such events, but its impact on outcomes outside clinical trials remained unclear.<br /><br />The retrospective study was conducted at a single institution, analyzing alectinib-treated patients, using electronic medical records. The primary aim was to assess how dose reductions affect progression, particularly CNS disease, and overall survival. Statistical analyses, including Fisher’s exact test and Kaplan-Meier survival analysis, showed no significant differences in new or progressive CNS disease and overall survival between reduced and non-reduced dosage groups.<br /><br />Of 57 eligible patients, 22.8% underwent dose reductions, commonly from 600 mg to 450 mg BID, mostly due to fatigue. The median time to dose reduction was three months, with the median treatment duration being 13.3 months for dose-reduced patients compared to 5.7 months for non-reduced patients. Prevalence of new or progressive CNS disease was 30% in the reduced group versus 13.6% in those without reduction, yet statistically insignificant.<br /><br />Conclusively, the study found dose reduction does not adversely impact patient outcomes, suggesting patients can manage side effects without compromising treatment effectiveness. However, due to the small sample size and single-institution scope, further extensive studies are necessary to generalize these findings and explore similar effects in other ALK inhibitors.

Asset Subtitle

Briana To

Meta Tag

Speaker Briana To

Topic Metastatic Non-small Cell Lung Cancer – Targeted Therapy

Keywords

ALK inhibitor

alectinib

dose reduction

non-small cell lung cancer

CNS metastases

ALEX trial

progression

overall survival

retrospective study

side effects