Optimal First-Line Treatment for ALK-Positive Advanced NSCLC Identified


A recent study compared a targeted therapy with standard chemotherapy for treatment-naïve anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC), published in BMC Cancer (online January 3, 2018; doi:10.1186/s12885-017-3720-8).

ALK rearrangements in NSCLC are associated with prolonged progression-free survival (PFS) in patients who received pemetrexed-based chemotherapy. However, with new tyrosine kinase inhibitors such as crizotinib entering the treatment landscape, comparative trials are needed to determine the optimal treatment strategy in this population.

A group of Chinese researchers led by Jianya Zhou, department of respiratory disease, Thoracic Disease Center, Zhejiang University, conducted a study to compare the efficacy of crizotinib, pemetrexed, and other chemotherapy regimens in the first-line setting for patients with ALK-positive advanced NSCLC in real-world clinical use. A total of 73 patients were enrolled and separated into three groups based on first-line treatment: crizotinib (n = 32), platinum-based pemetrexed (n = 28), and chemotherapy platinum-based non-pemetrexed (n = 13). Researchers noted that 68 of the patients received follow-up care in their hospital.

The main outcomes measured in the study were objective response rate (ORR), disease control rate (DCR), and PFS. A Kaplan-Meier analysis and a Cox proportional hazards model were utilized to evaluate clinical factors that helped predict the efficacy of crizotinib.

The resulting ORR, DCR, and PFS for each of the three treatment groups are noted in the below table.






78.1% (25/32)

100% (32/32)

16.1 months


17.9% (5/28)

57.2% (16/28)

6.0 months


15.4% (2/13)

46.2% (6/13)

2.9 months

As indicated, the PFS was significantly longer in the crizotinib group compared with the other groups, and the ORR and DCR was significantly greater in the crizotinib group compared with the other groups (P < .001).


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Additionally, Higher Eastern Cooperative Oncology Group (ECOG) performance status score and receiving crizotinib treatment after initial chemotherapy platinum-based non-pemetrexed therapy were factors associated with shorter PFS after crizotinib treatment.

Researchers concluded that crizotinib is superior to standard chemotherapy for patients with ALK-positive advanced NSCLC who did not receive previous treatment. Further research is necessary to validate this finding.—Zachary Bessette