Real-world outcomes of crizotinib treatment for ALK+ and ROS1+ metastatic non-small cell lung cancer in Nepal.

e20689 Background: Lung cancer remains the most common and most lethal cancer in Nepal. Although targeted therapies have changed the treatment and prognosis of mutation-driven non-small cell lung cancer (NSCLC), access to these agents remains limited in low- and middle-income countries (LMICs) due to high costs and under-resourced health systems. Multistakeholder access programs offer a pathway to expand availability of molecular therapies in these settings. Here we describe treatment outcomes for patients with ALK- or ROS1-positive metastatic NSCLC treated at Patan Academy of Health Sciences (PAHS) in Nepal and supported by the Max Access Solutions program. Methods: A retrospective analysis was conducted of patients with ALK or ROS1-positive metastatic NSCLC treated with Crizotinib at PAHS and enrolled in Max Access Solutions between January 1, 2018, and June 30, 2025. Demographic data, treatment duration, and survival status were collected using the Patient Access Tracking System (PATS) and summarized descriptively. Results: Of the 930 patients with metastatic NSCLC, 123 patients were enrolled: 101 with ALK-positive (82.1%) and 22 (17.9%) with ROS1-positive disease. Median age was 53 years, with a near-equal male (52.5%) and female (47.5%) distribution. All patients initiated treatment shortly after diagnosis (median 1 month). At the time of analysis, 52 patients remained on therapy (median duration: 8 months), and 13 (25%) had been on treatment for over 2 years. Among the 71 patients no longer receiving therapy, the median treatment duration was 13 months. Reasons for discontinuation included death (51.3%), progression of the disease (36.4%), and loss to follow-up (12.3%). Conclusions: NSCLC continues to exert a significant toll globally. While mutation-driven therapies have improved the prognosis of ALK and ROS1-positive lung cancer in high-income countries, access remains limited in LMICs. This evaluation demonstrates the feasibility and clinical benefit of providing Crizotinib to patients with ALK and ROS1-positive metastatic NSCLC in a resource-limited setting. Timely initiation enabled sustained treatment for many patients, with some achieving long-term benefit beyond two years, comparable to outcomes reported in high-income settings. These findings highlight the importance of multistakeholder partnerships in improving access to and cancer outcomes in LMICs.