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E. Verghese
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P1.03 - Chemotherapy/Targeted Therapy (ID 689)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.03-011 - Clinical Outcomes Correlated with Percentage of Positive Anaplastic-Lymphoma Kinase Cells Tested by FISH Analysis in NSCLC. (ID 9291)
09:30 - 09:30 | Author(s): E. Verghese
- Abstract
Background:
Testing for Anaplastic Lymphoma Kinase (ALK) rearrangement in patients diagnosed with Non-Small Cell lung Cancer (NSCLC) is the standard of care in the UK. 2-7% of tumours are positive and subsequently patients may be eligible for treatment with Tyrosine Kinase Inhibitors (TKIs). Response rates to TKIs range from 65-75% with a median PFS of 7.7-10.7 Months. We investigated the relationship between the percentage of ALK positive cells and clinical outcomes in a local patient cohort.
Method:
All patients found to have an ALK rearrangement between 1/1/13 - 1/4/17 in the Leeds Cancer Centre, UK were included. ALK analysis was performed using Fluorescent in situ Hybridisation (FISH) and the percentage of positive abnormal cells was recorded. Retrospective review of the medical notes was performed and outcomes documented including, whether the patient received a TKI, response to TKI, duration of response and overall survival. Chi-squared, Kaplan-Meier survival curves and log-rank test were used to assess survival outcomes.
Result:
75 patients were found to have an ALK rearrangement in total. Median age was 66 (range 51-92). Only 23 patients received a TKI. Until 2016 TKIs were not available in the first line setting in the UK and many patients were unable to receive a TKI either because first line chemotherapy was contra-indicated or because their performance status had deteriorated during first line chemotherapy making them unsuitable for a TKI. Some patients had early stage disease and therefore a TKI was not indicated (n=7). Median percentage of ALK positive cells was 27% and this was used as a cut off for further statistical analysis. Patients with > 26% of cells positive for ALK had a significantly higher chance of response (91.67% Vs. 42.86% p= 0.025). There was a trend towards improved PFS (107 vs 70 days) for those patients with >26% positivity. This was not statistically significant (PFS p=0.102) and no difference in overall survival was observed (OS p=0.421).
Conclusion:
In this small cohort, patients whose tumours had a higher proportion of tumour cells with an ALK rearrangement, were more likely to respond to TKI. They also had better PFS, though this was not significant. This study was limited by small numbers. TKIs are now available in the first-line setting, allowing more patients to access them. Future investigations will benefit from these increased numbers and if confirmed prospective studies, assessing more targeted use of TKIs on the basis of cellular positivity, could be considered.
