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Kapoor A, Noronha V, Patil V, Menon N, Joshi A, Kumar A, Singh AK, Mahajan A, Janu A, Kumar R, Pai T, Chougule A, Shetty O, Prabhash K. Clinical Profile, Practice Pattern, and Outcomes With First-Line Therapy in ALK-Positive Lung Cancer: Real-World Data From Resource-Constrained Settings. JTO Clin Res Rep 2022; 4:100443. [PMID: 36654881 PMCID: PMC9841022 DOI: 10.1016/j.jtocrr.2022.100443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction ALK inhibitors are one of the success stories in precision medicine for treating patients with advanced ALK-positive NSCLC. Nevertheless, developing countries have substantial constraints in using ALK inhibitors, with limited data from India. Methods An audit of a prospectively collected database of patients with advanced ALK-positive NSCLC treated from January 2013 to March 2018 was conducted. The SPSS version 20.0 was used for statistical analysis. Results A total of 441 patients were available for analysis; 62.5% were males, median age was 50 (range: 19-75) years, and 78.3% had Eastern Cooperative Oncology Group performance status of 0 to 1. When all the lines of therapies were included in the analysis, ALK inhibitors could be used in 379 (85.9%) of the total ALK-positive patients and 292 patients (66.2%) received ALK inhibitors in the first line in any strategy. The major reason for not starting ALK inhibitors upfront was financial constraints in 69% of the patients. The median progression-free survival on first-line therapy for the entire cohort was 14.1 months (95% confidence interval [CI]: 12.2-15.9), with a significant difference between patients receiving ALK inhibitor in first line in any strategy versus not in first line (17.2 mo [95% CI: 14.5-19.9] versus 5.9 mo [95% CI: 4.2-7.6], p < 0.001). The median overall survival was 30.7 months (95% CI: 27.3-34.2), with 37.6 months (95% CI: 28.1-47.1) for ALK inhibitor in the first line versus 20.5 months (95% CI: 15.8-25.1) for subsequent lines of therapy (p < 0.001). Conclusions Most of our patients with ALK-positive NSCLC were exposed to ALK inhibitors through various support mechanisms. Those patients who could receive ALK inhibitors in the first line had a significant survival advantage as compared with others.
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Affiliation(s)
- Akhil Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center and Homi Bhabha Cancer Hospital (A Unit of Tata Memorial Centre, Mumbai), Varanasi, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amit Kumar
- Department of Medical Oncology, Homi Bhabha Cancer Hospital (A Unit of Tata Memorial Centre, Mumbai), Muzaffarpur, India
| | - Ajay Kumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amit Janu
- Department of Radiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rajiv Kumar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Trupti Pai
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anuradha Chougule
- Department of Molecular Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Omshree Shetty
- Department of Molecular Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India,Corresponding author. Address for correspondence: Kumar Prabhash, MD, DM, ECMO, Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Ernst Borges Road, Parel, Mumbai 400012, India.
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Noronha V, Chougule A, Chandrani P, Kaushal RK, Patil VM, Menon N, Kapoor A, Chopade S, Singh A, Shetty O, Dutt A, Banavali S, Prabhash K. Lung cancer with dual EGFR and ALK driver alterations at baseline: a retrospective observational cohort study. Acta Oncol 2022; 61:1143-1147. [PMID: 35972844 DOI: 10.1080/0284186x.2022.2109426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Vanita Noronha
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | | | - Pratik Chandrani
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Nandini Menon
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | | | - Sunil Chopade
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Ajaykumar Singh
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Omshree Shetty
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Amit Dutt
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
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Garg N, Kothari R. ALK Inhibitors in Nonsmall Cell Lung Cancer. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1729728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Nitish Garg
- Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Rushabh Kothari
- Cancure Cancer Center, Narayana Multispeciality Hospital, Ahmedabad, Gujarat, India
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Chen MT, Fu XH, Huang H, Wang Z, Fang XJ, Yao YY, Ren QG, Chen ZG, Lin TY. Combination of crizotinib and chemotherapy in patients with relapsed or refractory anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL). Leuk Lymphoma 2020; 62:571-580. [PMID: 33155495 DOI: 10.1080/10428194.2020.1839658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Our aim was to explore the role of crizotinib, targeted anaplastic lymphoma kinase (ALK), on r/r systemic anaplastic large cell lymphoma (sALCL). The treated group prospectively screened 20 patients. After taking crizotinib in the first week, 16 patients who were tolerant and sensitive received the combination of crizotinib with chemotherapy. The control group included 27 patients receiving chemotherapy in the same hospital during the same period. The objective remission rates of the treated and control group were 81.3% and 74.1% (p = .869), respectively. The progression-free survival rates at two years in treated and control group were 68.7% and 45.0% (HR = 0.42, 95% CI 0.17-0.99, p < .05), respectively. The overall survival rates at two years in the treated and control group were 86.1% and 78.9% (p = .385, HR = 0.51, 95% CI 0.11-2.30), respectively. The main adverse events included elevated transaminase, diarrhea, and vision abnormalities. Thus, the combination of crizotinib with chemotherapy might be effective in ALK-positive and crizotinib sensitive r/r sALCL patients.
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Affiliation(s)
- Mei-Ting Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiao-Hong Fu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Oncology, Shenzhen Nanshan People's Hospital, Shenzhen, China.,Department of Medical Oncology, Affiliated Shenzhen Sixth Hospital of Guangdong Medical University, Shenzhen, China
| | - He Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhao Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiao-Jie Fang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yu-Yi Yao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Quan-Guang Ren
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ze-Geng Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Tong-Yu Lin
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Mok T, Peters S, Camidge DR, Noé J, Gadgeel S, Ignatius Ou SH, Kim DW, Konopa K, Pozzi E, Liu T, Loftin IR, Williams C, Shaw AT. Outcomes According to ALK Status Determined by Central IHC or FISH in Patients with ALK-Positive NSCLC Enrolled in the Phase III ALEX Study. J Thorac Oncol 2020; 16:S1556-0864(20)30815-7. [PMID: 34756882 DOI: 10.1016/j.jtho.2020.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION We retrospectively examined progression-free survival (PFS) and response by ALK fluorescence in-situ hybridization (FISH) status in patients with advanced ALK immunohistochemistry (IHC)-positive non-small-cell lung cancer (NSCLC) in the ALEX study. METHODS 303 treatment-naïve patients were randomized to receive twice-daily alectinib 600 mg or crizotinib 250 mg. ALK status was assessed centrally using Ventana ALK (D5F3) CDx IHC and Vysis ALK Break Apart FISH Probe Kit. Primary endpoint: investigator-assessed PFS. Secondary endpoints of interest: objective response rate (ORR) and duration. RESULTS Investigator-assessed PFS was significantly prolonged with alectinib versus crizotinib in ALK IHC-positive/FISH-positive tumors (n = 203, 67%) (HR 0.37, 95% CI: 0.25-0.56) and ALK IHC-positive/FISH-uninformative tumors (n = 61, 20%) (HR 0.39, 95% CI: 0.20-0.78), but not ALK IHC-positive/FISH-negative tumors (n = 39, 13%) (HR 1.33, 95% CI: 0.6-3.2). ORRs were higher with alectinib versus crizotinib in ALK IHC-positive/FISH-positive tumors 90.6% versus 81.4%; stratified odds ratio [OR] 2.22, 95% CI: 0.97-5.07) and ALK IHC-positive/FISH-uninformative tumors (96.0% versus 75.0%; OR 9.29, 95% CI: 1.05-81.88), but not ALK IHC-positive/FISH-negative tumors (28.6% versus 44.4%; OR 0.45, 95% CI: 0.12-1.74). Next-generation sequencing (NGS) was performed in 35/39 patients with ALK IHC-positive/FISH-negative tumors; no ALK fusion was identified in 20/35 (57.1%) patients by NGS, but 10/20 (50.0%) had partial response/stable disease. CONCLUSION Outcomes of patients with ALK IHC-positive/FISH-positive and ALK IHC-positive/FISH-uninformative NSCLC were similar to the overall ALEX population. These results suggest that Ventana ALK IHC is a standard testing method for selecting patients for treatment with alectinib.
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Affiliation(s)
- Tony Mok
- State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Hong Kong.
| | | | | | | | - Shirish Gadgeel
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Dong-Wan Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Krzysztof Konopa
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Ting Liu
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | | | - Alice T Shaw
- Massachusetts General Hospital, Boston, Massachusetts
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Nassif S, El-Zaatari ZM, Attieh M, Hijazi M, Fakhreddin N, Aridi T, Boulos F. Lack of expression of ALK and CD30 in breast carcinoma by immunohistochemistry irrespective of tumor characteristics. Medicine (Baltimore) 2019; 98:e16702. [PMID: 31393373 PMCID: PMC6709128 DOI: 10.1097/md.0000000000016702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
CD30 is a member of the tumor necrosis factor family of cell surface receptors normally expressed in lymphocytes, as well as some lymphomas, but has been described in other malignancies. Anaplastic lymphoma kinase (ALK) is a tyrosine kinase receptor that belongs to the insulin receptor superfamily, and is normally expressed in neural cells, but has been detected in several malignancies. There is conflicting data in the literature that describes the expression of these receptors in breast cancer, and the aim of this study is to test the expression of CD30 and ALK in a cohort of Middle Eastern patients with breast carcinoma.Cases of invasive breast cancer from the archives of AUBMC were reviewed over a period of 9 years, and the blocks that were used for immunohistochemical staining for ER, PR, Her-2/neu were selected. Immunohistochemical staining for CD30 (JCM182) and ALK (5A4 and D5F3) was performed.Two hundred eighty-four cases were identified (2 cases were male), with a mean age of 55 ± 12. CD30 and ALK expression was not seen in any of the cases.Our cohort showed complete negativity to both CD30 and ALK, adding to the conflicting data available in the literature, and more studies are needed to reliably identify a trend of expression of CD30 and ALK in breast carcinoma, especially in the Middle East.
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