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Real-World Treatment and Outcomes of ALK-Positive Metastatic Non-Small Cell Lung Cancer in a Southeast Asian Country

Poh ME 1 , How SH 2 , Ho GF 3 , Pang YK 1 , Hasbullah HH 4 , Tho LM 5 Show all authors , Muhamad Nor I 6 , Lim BC 7 , Ho KF 8 , Thiagarajan M 6 , Samsudin A 9 , Omar A 10 , Ong CK 11 , Soon SY 12 , Tan JYK 9 , Zainal Abidin MA 2

Affiliations 

  • 1 Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
  • 2 Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
  • 3 Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
  • 4 Faculty of Medicine, Universiti Teknologi Mara, Sungai Buloh, Selangor, Malaysia
  • 5 Department of Clinical Oncology, Beacon Hospital, Petaling Jaya, Selangor, Malaysia
  • 6 Oncology and Radiotherapy Department, General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  • 7 Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
  • 8 Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
  • 9 Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
  • 10 Respiratory Unit, Medical Department, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
  • 11 Gleneagles Penang, George Town, Penang, Malaysia
  • 12 Sarawak Heart Centre, Kuching, Sarawak, Malaysia
Cancer Manag Res, 2023;15:31-41.
PMID: 36660237 DOI: 10.2147/CMAR.S393729

Abstract

PURPOSE: Anaplastic lymphoma kinase (ALK) inhibitors are associated with good overall survival (OS) for ALK-positive metastatic non-small cell lung cancer (NSCLC). However, these treatments can be unavailable or limited by financial constraints in developing countries. Using data from a nationwide lung cancer registry, the present study aimed to identify treatment patterns and clinical outcomes of ALK-positive NSCLC in Malaysia.

METHODS: This retrospective study examined data of patients with ALK-positive NSCLC from 18 major hospitals (public, private, or university teaching hospitals) throughout Malaysia between January 1, 2015 and December 31, 2020 from the National Cardiovascular and Thoracic Surgical Database (NCTSD). Data on baseline characteristics, treatments, radiological findings, and pathological findings were collected. Overall survival (OS) and time on treatment (TOT) were calculated using the Kaplan-Meier method.

RESULTS: There were 1581 NSCLC patients in the NCTSD. Based on ALK gene-rearrangement test results, only 65 patients (4.1%) had ALK-positive advanced NSCLC. Of these 65 patients, 59 received standard-of-care treatment and were included in the analysis. Crizotinib was the most commonly prescribed ALK inhibitor, followed by alectinib and ceritinib. Patients on ALK inhibitors had better median OS (62 months for first-generation inhibitors, not reached at time of analysis for second-generation inhibitors) compared to chemotherapy (27 months), but this was not statistically significant (P=0.835) due to sample-size limitations. Patients who received ALK inhibitors as first-line therapy had significantly longer TOT (median of 11 months for first-generation inhibitors, not reached for second-generation inhibitors at the time of analysis) compared to chemotherapy (median of 2 months; P<0.01).

CONCLUSION: Patients on ALK inhibitors had longer median OS and significantly longer TOT compared to chemotherapy, suggesting long-term benefit.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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