Real-World Treatment Patterns And Outcomes In Patients (Pts) With Advanced, Alk Plus Non-Small Cell Lung Cancer (Nsclc) In Europe

The availability of a vast real-world dataset (RWD) in a rare NSCLC subtype is limited. We analyzed pt demographics, location of metastasis, time on treatment (ToT) and treatment patterns in a retrospective cohort with advanced ALK+ NSCLC in the United Kingdom (UK) and Germany. De-identified pt data collected from May to October 2019 were analyzed. Physicians completed the online pt-level data collection form, in the Medimix LiveTracker™, for most recent pts by abstracting data from each pt’s medical record. All approved ALK inhibitors and other treatments were evaluated and displayed if used in > 3% of pts. Data from 605 pts from the UK (N=299) and Germany (N=306). First-line regimens included crizotinib (34%), alectinib (31%), chemotherapy (CT) (7%), CT + checkpoint inhibitor (CPI) (3%) and CPI alone (3%). Second-line regimens included alectinib (30%), brigatinib (18%), ceritinib (14%), crizotinib (9%), CT (3%), CT + CPI (4%) and CPI alone (3%). The most common sites of metastasis at diagnosis were: liver (31%), bone (30%) and CNS (19%). Of pts receiving an ALK inhibitor with >3% use in first-line baseline demographics, site of metastatic progression and ToT are shown in the table below.Table:Baseline characteristicsAlectinib (N=70)Crizotinib (N=229)Median Age6263Female Sex (%)40%46%Overall median ToT in days (d)360 d470 dCNS metastasis at diagnosis (%;median ToT)21% (454 days)14% (518 d)Site of metastatic progression after first-lineCNS (%; median ToT)13% (243 d)30% (455 d)Visceral (%; median ToT)66% (394 d)48% (441 d)Bone (%; median ToT)30% (365 d)27% (319 d) Open table in a new tab Many pts with advanced ALK+ NSCLC receive at least two lines of treatment. Data support alectinib’s greater intracranial activity compared to crizotinib, with higher visceral metastasis rates and similar bone metastasis rates at progression. Despite the CNS protective effect, ToT (a surrogate for time to progression) was not improved. Possible explanations include shorter follow-up with alectinib due to more recent approval and effective co-treatments, including radiotherapy. As this RWD mature, it may deepen the understanding of how treatments and their sequencing influence pt outcomes in ALK+ NSCLC.