Author of

• 17629

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  P2.03b - Poster Session with Presenters Present (ID 465)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Advanced NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 17642

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    P2.03b-013 - Outcome of Patients with ALK+ NSCLC and Brain Metastases in Relation to Disease Burden and Clinical Management (ID 5086)

    14:30 - 14:30  |  Author(s): C. Lenneby Helleday
    • Abstract
    • Slides

    Background:
    The management of ALK+ NSCLC patients with CNS metastases represents a clinical challenge. We conducted this single institution retrospective analysis in order to evaluate the frequency of CNS metastases in this patient group and explore clinical features associated with survival
    
    Methods:
    Between 2011 and 2016, 70 patients with advanced ALK+ adenocarcinoma were treated at our institution. Data on CNS imaging modality, treatment strategy and outcome was collected by chart review
    
    Results:
    CNS imaging was performed with either MRI(36%) or CECT(64%) in 59 cases, and CNS metastases were diagnosed in 56% of examined subjects. The characteristics of these 33 patients were as follows: gender male/female 45%/54%; median age 60y (IQR 50-65); # of CNS metastases 1-3/4-10/>10 21%/36%/42% (including 3 subjects with leptomeningeal involvement); timing for diagnosis of CNS metastases: at primary cancer diagnosis (21%), at PD on chemotherapy (33%), at PD on crizotinib (39%), at PD on 2[nd] generation ALKi (6%). Radiotherapy was administered as either SRS(42%) or WBRT(58%) in 66% of cases. Overall medical treatment was chemotherapy (n=32); crizotinib (n=28); 2[nd] generation ALKi, either alectinib, ceritinib or brigatinib (n=22). The first treatment strategy upon diagnosis of CNS metastases was radiotherapy alone, crizotinib or a 2[nd] gen ALKi in 42%, 24% and 33% of subjects, respectively. In 4 cases, the 2[nd] generation ALKi was started directly after completion of radiotherapy. Median OS from the diagnosis of CNS metastasis was 18 months (95% CI 9-50). 1- and 2-year survival rates were 59% and 44%, respectively. Cox proportional hazard analysis showed that neither gender, age, timing for diagnosis of CNS metastasis nor the use of radiotherapy were significant prognostic factors for OS in this patient cohort. Survival analysis stratified by Number of CNS metastasis showed a trend favoring 1-3 met (median OS 59 months) vs 4-10 and >10 lesions (median OS of 25 and 9 months, respectively), with the three survival curves crossing each other (p=0.1). On the other hand, the first treatment strategy after the diagnosis of CNS metastases was shown to be indeed a significant prognostic factor for OS. Median OS for patients treated with crizotinib, radiotherapy alone or a 2[nd] ALKi (with or without RT) was 9 months, 29 months and Not reached, respectively (p=0.03).
    
    Conclusion:
    This retrospective study confirms the high incidence of CNS metastases in Caucasian patients with advanced ALK+ NSCLC. The wider implementation of 2[nd] generation ALKi in clinical practice may change the prognosis of these subjects
    
    

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