Real-world evolution of first-line ALK-positive NSCLC management in Spain

To describe real-world management of patients with ALK-positive advanced or metastatic NSCLC receiving first-line therapy in Spain, and to assess shifts in treatment patterns following the pricing and reimbursement of lorlatinib for first-line treatment in Spain. This retrospective, cross-sectional analysis used data from the IQVIA Oncology Dynamics™ database. Patients with ALK-positive advanced or metastatic NSCLC receiving first-line treatment in Spain were included in two cohorts: before (July 2021–June 2022) and after (July 2024–June 2025) lorlatinib introduction. Patient characteristics, molecular profiles, and treatment patterns were described using descriptive statistics. A total of 342 patients were included. Patient characteristics were generally comparable across cohorts, although a higher disease burden and increased frequency of brain metastases were observed over time. A marked shift in treatment patterns was reported, with lorlatinib use increasing from 2 to 46% and becoming the most frequently prescribed first-line therapy in the later cohort, while alectinib use decreased from 85 to 41%. Among newly treated patients, lorlatinib accounted for 67% of prescriptions in the later cohort. Uptake of next-generation sequencing for molecular testing increased, and radiotherapy use declined over time. The management of ALK-positive NSCLC in Spain has evolved following the pricing and reimbursement of lorlatinib for first-line treatment in Spain, with changes in treatment selection and molecular testing practices observed in routine clinical settings.