Clinical characteristics of ALK-positive NSCLC patients treated with sequential ALK-TKI therapies in a single-centre

Introduction Although sequential treatment with ALK-TKIs for ALK-positive lung cancer is commonly practiced in clinical settings, there are few reports on the actual treatment choices, efficacy and safety.Methods This retrospective study evaluated the treatment sequence, progression-free survival (PFS), overall survival (OS), and adverse events (AEs) for the patients who received two or more ALK-TKIs.Results Eleven patients were included in the study. The median age was 59 years, and five patients (45.5%) were female. The number of ALK-TKIs administered was two in five patients, three in five patients, and four in one patient. The drugs used were Alectinib in 10 patients, Lorlatinib in eight, Brigatinib in six, Ceritinib in three, and Crizotinib in two. Six patients (54.5%) had a history of treatment with cytotoxic chemotherapy in addition to ALK-TKIs. The most common first-line drug was Alectinib, followed by Brigatinib and Crizotinib. The median PFS for each treatment line was 23 months for the first line, 17 months for the second, 14 months for the third, and 5 months for the fourth. The median OS from 1st ALK-TKI was 58 months. Discontinuation of ALK-TKI due to adverse events occurred in six of the total treatment cases, and five of these (83.3%) were attributed to Brigatinib.Conclusion Sequential treatment with different types of ALK-TKIs demonstrated a certain degree of efficacy. However, the incidence of discontinuation due to adverse events was higher for Brigatinib than for other ALK-TKIs.