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Updated overall survival (OS) and safety data from the randomized, phase III ALEX study of alectinib (ALC) versus crizotinib (CRZ) in untreated advanced ALK+ NSCLC.
Journal article

Updated overall survival (OS) and safety data from the randomized, phase III ALEX study of alectinib (ALC) versus crizotinib (CRZ) in untreated advanced ALK+ NSCLC.

  • Peters, Solange Lausanne University Hospital (CHUV), Lausanne University, Lausanne, Switzerland;
  • Mok, Tony S. K. State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Shatin, NT, Hong Kong, China;
  • Gadgeel, Shirish M. Department of Internal Medicine, Rogel Cancer Center/University of Michigan, Ann Arbor, MI;
  • Rosell, Rafael Catalan Institute of Oncology, Barcelona, Spain;
  • Dziadziuszko, Rafal Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland;
  • Kim, Dong-Wan Seoul National University Hospital, Seoul, South Korea;
  • Perol, Maurice Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France;
  • Ou, Sai-Hong Ignatius Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA;
  • Shaw, Alice Tsang Institute of Cancer Sciences, Massachusetts General Hospital, Boston, MA;
  • Bordogna, Walter F. Hoffmann-La Roche Ltd., Basel, Switzerland;
  • Smoljanovic, Vlatka F. Hoffmann-La Roche Ltd., Basel, Switzerland;
  • Hilton, Magalie F. Hoffmann-La Roche Ltd., Basel, Switzerland;
  • Ruf, Thorsten F. Hoffmann-La Roche Ltd., Basel, Switzerland;
  • Archer, Venice Rosale F. Hoffmann-La Roche Ltd., Basel, Switzerland;
  • Camidge, D. Ross University of Colorado, Denver, CO;
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Published in:
  • Journal of Clinical Oncology. - American Society of Clinical Oncology (ASCO). - 2020, vol. 38, no. 15_suppl, p. 9518-9518
Cancer Research
Oncology
English 9518 Background: Final, mature PFS from the global phase III ALEX study (NCT02075840) of ALC vs CRZ in untreated, advanced/metastatic ALK+ NSCLC have been previously published: ALC 34.8 months (m) (95% CI 17.7–NR) vs CRZ 10.9 m (95% CI 9.1–12.9), (HR 0.43, 95% CI 0.32–0.58). We report 5-year OS and updated safety data from ALEX with a further 12 m follow-up (FU) (cutoff date: Nov 29, 2019). Methods: Patients (pts) with stage IIIB/IV ALK+ NSCLC (by central IHC), ECOG PS 0–2 and no prior systemic therapy for advanced NSCLC were randomized 1:1 to ALC 600 mg BID (n = 152) or CRZ 250 mg BID (n = 151). Asymptomatic CNS metastases (mets) at baseline (BL) were allowed. OS was a secondary endpoint, and no formal statistical testing was planned. Results: Median duration of FU: 48.2 m with ALC vs 23.3 m with CRZ. OS data remain immature (events: 37%; stratified HR 0.67 [95% CI 0.46–0.98]); median OS with CRZ was 57.4 m (95% CI 34.6–not estimable [NE]) vs NE with ALC. The 5-year survival rate was 62.5% (95% CI 54.3–70.8) with ALC vs 45.5% (95% CI 33.6–57.4) with CRZ (Table). In pts with CNS mets at BL the OS HR was 0.58 (95% CI 0.34–1.00) and 0.76 (95% CI 0.45–1.26) in pts without CNS mets at BL. The OS benefit of ALC vs CRZ was generally consistent across all subgroups. Considering the longer treatment duration for ALC (28.1 m) vs the previous analysis (27.7 m), the safety profile of ALC remains consistent; no new safety signals were observed. With ALC, 35% of pts remain on study treatment vs 9% of pts remaining on CRZ. In pts with ≥1 known post-progression treatment (ALC: 32.2%; CRZ: 45.7%), lorlatinib was the most common ALK TKI received after first-line ALC (7.2%), compared with ceritinib after first-line CRZ (15.2%). Conclusions: This is the first global randomized study of a 2nd generation ALK TKI to demonstrate a clinically meaningful improvement in OS vs CRZ in ALK+ NSCLC (5-year survival rate: 62.5%, ALC vs 45.5%, CRZ); longer FU is required as OS data remain immature. Clinical trial information: NCT02075840 . [Table: see text]
Language
  • English
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closed
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https://sonar.ch/global/documents/46294
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