Brigatinib Yields Durable Benefit in ALK NSCLC

Researchers investigated brigatinib discontinuation and tyrosine kinase inhibitor (TKI) therapy for patients with anaplastic lymphoma kinase positive (ALK+) non-small cell lung cancer (NSCLC). Although limited data are available for ALK TKI sequencing, next-generation targeted therapies are known to provide improved clinical outcomes. The following data were presented at the virtual 2021 ESMO Congress.

A total of 413 patients, identified via IQVIA’s Pharmacy Claims Database, were included in the study, with at least one year or more of data available between April 2017 and September 2020.

 Kaplan-Meier models estimated time to treatment discontinuation (TTD) for brigatinib and subsequent ALK TKI sequencing. 

“Prior to initiating brigatinib, 195 patients had front-line crizotinib with or without subsequent ALK TKIs, 133 had crizotinib followed by alectinib and/or certinib, 62 had only crizotinib, 99 had only alectinib, and 80 had no observed ALK TKI present,” explained Mohammad Jahanzeb, MD, Hematology-Oncology Department, Florida Precision Oncology, and co-investigators.

The median brigatinib TTD was 10.3 months (95% CI, 8.2-15.0). 167 (40.4%) patients discontinued brigatinib or switched to an alternate ALK TKI. Among them, 100 (59.9%) received subsequent ALK TKIs.

The most common ALK TKI chosen after brigatinib discontinuation was lorlatinib (57.0%), followed by brigatinib retreatment (16.0%), alectinib (13.0%), ceritinib (10.0%), and crizotinib (4.0%). The median TTD of post-brigatinib ALK TKIs was 7.2 months (95% CI, 3.9-13.8).

Furthermore, the median TTD of post-brigatinib ALK TKI for those who received crizotinib then brigatinib was 6.7 months (95% CI, 3.7-22.2), while those who received lorlatinib after brigatinib discontinuation was 8.0 months (95% CI, 3.9-not reached).

These results highlight brigatinib as a real-world clinical option with durable effects shown in this ALK+ NSCLC patient population.

“Treatment with subsequent TKIs can still bring benefit to patients after discontinuing brigatinib. More formalized prospective data are needed to establish sequencing recommendations,” concluded Dr Jahanzeb, et al. —Alexa Stoia

M.O. Jahanzeb, H.M. Lin, Y. Wu.Treatment sequencing and duration of subsequent tyrosine kinase inhibitors in ALK+ non-small cell lung cancer patients treated with brigatinib in the US. Presented at: the ESMO Virtual Congress 2021; September 16-21, 2020; virtual. Abstract 1205P.