Puyuan Xing1, Shouzheng Wang1, Qiang Wang2, Di Ma1, Xuezhi Hao1, Mengzhao Wang3, Yan Wang1, Li Shan2, Tao Xin4, Li Liang5, Hongge Liang3, Yang Du4, Zhaohui Zhang5, Junling Li6. 1. Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China. 2. Department of Pulmonary Medicine (Inpatient Area 1), Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China. 3. Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, China. 4. Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin, China. 5. Department of Tumor Chemotherapy and Radiation Sickness, Peking University Third Hospital, Beijing, China. 6. Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China. lijunling@cicams.ac.cn.
Abstract
BACKGROUND: The efficacy of crizotinib for anaplastic lymphoma kinase (ALK)-rearranged non-small-cell lung cancer (NSCLC) patients with brain metastasis is controversial. Real-world research data are needed as further evidence. OBJECTIVE: We conducted a multicenter, retrospective study to explore how crizotinib affects the control of brain metastasis and the survival outcomes among Chinese patients. PATIENTS AND METHODS: We reviewed the medical records of unselected ALK-rearranged NSCLC patients treated with crizotinib at five hospitals in China from January 1, 2013 to November 30, 2017. Patients developing brain metastasis either before or during crizotinib treatment were included. Survival outcomes were analyzed by the Kaplan-Meier method, and prognostic factors were analyzed by multivariate Cox regression. RESULTS: A total of 174 patients were included in the analysis; 95 of these patients had baseline brain metastasis, while 79 patients developed brain metastasis during crizotinib treatment. Among patients with baseline brain metastasis, the median intracranial time to progression was 19.3 months (95% confidence interval [CI] 12.5-26.2) and the median overall survival (OS) was 53.4 months (95% CI not reached). A total of 135 patients experienced intracranial progression, and 94 of these patients continued crizotinib beyond progressive disease (CBPD). There was no significant difference in the median OS between patients with CBPD and without CBPD (48.3 months vs 53.4 months; p = 0.296). CONCLUSIONS: ALK-rearranged advanced NSCLC patients with baseline brain metastasis can still achieve OS benefits from crizotinib treatment. However, patients with intracranial progression may not obtain a long-term survival benefit from continuation of CBPD.
BACKGROUND: The efficacy of crizotinib for anaplastic lymphoma kinase (ALK)-rearranged non-small-cell lung cancer (NSCLC) patients with brain metastasis is controversial. Real-world research data are needed as further evidence. OBJECTIVE: We conducted a multicenter, retrospective study to explore how crizotinib affects the control of brain metastasis and the survival outcomes among Chinese patients. PATIENTS AND METHODS: We reviewed the medical records of unselected ALK-rearranged NSCLCpatients treated with crizotinib at five hospitals in China from January 1, 2013 to November 30, 2017. Patients developing brain metastasis either before or during crizotinib treatment were included. Survival outcomes were analyzed by the Kaplan-Meier method, and prognostic factors were analyzed by multivariate Cox regression. RESULTS: A total of 174 patients were included in the analysis; 95 of these patients had baseline brain metastasis, while 79 patients developed brain metastasis during crizotinib treatment. Among patients with baseline brain metastasis, the median intracranial time to progression was 19.3 months (95% confidence interval [CI] 12.5-26.2) and the median overall survival (OS) was 53.4 months (95% CI not reached). A total of 135 patients experienced intracranial progression, and 94 of these patients continued crizotinib beyond progressive disease (CBPD). There was no significant difference in the median OS between patients with CBPD and without CBPD (48.3 months vs 53.4 months; p = 0.296). CONCLUSIONS:ALK-rearranged advanced NSCLCpatients with baseline brain metastasis can still achieve OS benefits from crizotinib treatment. However, patients with intracranial progression may not obtain a long-term survival benefit from continuation of CBPD.