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Real-world comparative effectiveness of first-line alectinib versus crizotinib in patients with advanced ALK-Positive NSCLC with or without baseline central nervous system metastases
Zhang, Q. Lin, J. J. Pal, N. Polito, L. Trinh, H. Hilton, M. Smoljanović, V. Kurtsikidze, N. Archer, V. Krebs, Matthew G
Zhang, Q.
Lin, J. J.
Pal, N.
Polito, L.
Trinh, H.
Hilton, M.
Smoljanović, V.
Kurtsikidze, N.
Archer, V.
Krebs, Matthew G
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Abstract
Introduction: Alectinib was found to have superior efficacy to crizotinib in the phase 3 ALEX study and is a preferred initial treatment for patients with advanced ALK-positive NSCLC. To understand the efficacy of alectinib in U.S. clinical practice, we conducted a retrospective real-world comparative effectiveness analysis of first-line alectinib versus crizotinib.
Methods: Adults with advanced ALK-positive NSCLC who received first-line alectinib (from December 11, 2015) or crizotinib (from January 1, 2014) were included from a real-world database. Propensity scores were applied to balance baseline characteristics. Real-world data (RWD), including real-world progression-free survival (rwPFS), real-world overall survival, real-world time to new central nervous system (CNS) metastases, and outcomes in patients with or without baseline CNS metastases were analyzed. The ALEX-like RWD cohort (filtered by ALEX laboratory eligibility criteria) was used to compare real-world comparative effectiveness with ALEX.
Results: The RWD cohort comprised 364 patients (141 alectinib; 223 crizotinib); rwPFS (weighted hazard ratio [wHR] = 0.46, 95% confidence interval [CI]: 0.33-0.65) and real-world overall survival (wHR = 0.46, 95% CI: 0.31-0.69) were significantly improved with alectinib versus crizotinib. In patients with baseline brain scans, a substantial rwPFS benefit was found regardless of baseline CNS metastases. Real-world time to new CNS metastases was delayed with alectinib versus crizotinib in patients with (wHR = 0.28, 95% CI: 0.16-0.52) and without (wHR = 0.42, 95% CI: 0.24-0.76) baseline CNS metastases. The ALEX-like RWD cohort comprised 325 patients (120 alectinib; 205 crizotinib); alectinib was found to have similar rwPFS benefits with ALEX.
Conclusions: Outcomes were significantly improved with first-line alectinib versus crizotinib in patients with advanced ALK-positive NSCLC in the U.S. real-world setting.
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2023
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Zhang Q, Lin JJ, Pal N, Polito L, Trinh H, Hilton M, et al. Real-World Comparative Effectiveness of First-Line Alectinib Versus Crizotinib in Patients With Advanced ALK-Positive NSCLC With or Without Baseline Central Nervous System Metastases. JTO clinical and research reports. 2023 Apr;4(4):100483. PubMed PMID: 37025119. Pubmed Central PMCID: PMC10070922. Epub 2023/04/08. eng.