Real-world outcomes according to treatment strategies in ALK-rearranged non-small-cell lung cancer (NSCLC) patients: an Italian retrospective study

PURPOSE

Anaplastic lymphoma kinase (ALK) rearrangement confers sensitivity to ALK inhibitors (ALKis) in non-small-cell lung cancer (NSCLC). Although several drugs provided an impressive outcome benefit, the most effective sequential strategy is still unknown. We describe outcomes of real-life patients according to the treatment strategy received.

PATIENTS

We retrospectively collected 290 ALK rearranged advanced NSCLC diagnosed between 2011 and 2017 in 23 Italian institutions.

RESULTS

After a median follow-up of 26 months, PFS for crizotinib and a new generation ALKis were 9.4 [CI 95% 7.9-11.2] and 11.1 months [CI 95% 9.2-13.8], respectively, while TTF were 10.2 [CI 95% 8.5-12.6] and 11.9 months [CI 95% 9.7-17.4], respectively, being consistent across the different settings. The composed outcomes (the sum of PFS or TTF) in patients treated with crizotinib followed by a new generation ALKis were 27.8 months [CI 95% 24.3-33.7] in PFS and 30.4 months [CI 95% 24.7-34.9] in TTF. The median OS from the diagnosis of advanced disease was 39 months [CI 95% 31.8-54.5]. Patients receiving crizotinib followed by a new generation ALKis showed a higher median OS [57 months (CI 95% 42.0-73.8)] compared to those that did not receive crizotinib [38 months (CI 95% 18.6-NR)] and those who performed only crizotinib as target agent [15 months (CI 95% 11.3-34.0)] (P < 0.0001).

CONCLUSION

The sequential administration of crizotinib and a new generation ALKis provided a remarkable clinical benefit in this real-life population, being an interesting option to consider in selected patients.

Abstract P1-03-08: New diagnostic tools for bone health assessment: Perspectives in medical oncology

Background

Pituitary down regulators, aromatase inhibitors tamoxifen and chemotherapeutic drugs, all have a negative impact on bone health in breast cancer patients.

Although trabecular bone accounts for only 20% of skeleton mass, bone resistance depends also on the its micro-architecture, or quality, of, in addition to bone density. The BESTEST® is an innovative and inexpensive diagnostic method that gives an indication of the quality of the bone structure: it measures the weight-bearing capacity of the bone structure, evaluated from simulated application of loads on bone structure images acquired by radiograms in the proximal epiphysis of the hand. Results are expressed as BSI_T-score and BSI_Z-score (which refers the results to the average value for the same age) and provide precious add-on information to densitometry.

We discuss the preliminary results obtained in female patients undergoing breast cancer treatment.

Material and methods

100 Caucasian women, took BESTEST® as follow-up while undergoing oncological treatment. Femoral neck DXA T-score available in a subgroup of 60. 10 patients self-reported an osteoporotic fracture, DXA T-score available for 8.

Control population: 200 women, accessing BESTEST® and DXA for screening purposes, 30 self-reporting an osteoporotic fracture.

Results

Statistics: mean (min, max). NAgeBSI_T-scoreBSI_Z-scoreDXA_T-scorePopulation10061 (33, 88)-1.7 (-3.4, -0.0)-1.3 (-2.6, 0.6)NADXA subgroup (of oncological population)6062 (35, 88)-1.8 (-3.4, -0.1)-1.3 (-2.6, 0.6)-1.6 (-3.2, 0.5)Fractured subgroup1067 (56, 82)-2.4 (-2.9, -1.3)-1.8 (-2.6 -0.1)NAFractured subgroup with DXA868 (60, 82)-2.4 (-2.9, -1.3)-1.8 (-2.6 -0.1)-1.5 (-2.9, 0.1)Control20063 (32, 89)-1.1 (-3.6, 2.9)-0.6 (-3.0, 2.9)-1.9 (-3.7, 1.0)

The fractured subgroup exhibits significantly lower BSI T-score than the population (T-test p&lt; 0.0100) and results are similar after BSI Z-score correction for age (T-test p = 0.0300). The BSI T-score of the DXA subgroup is representative of the oncological population undergoing treatment (T-test p=0.8668).

As expected, BSI T-score and DXA T-score are not correlated: R2 = 0.0917 in the control and R2 = 0.0294 in the population. The DXA subgroup exhibit significantly lower BSI T-score than the control (T-test p = 0.0002) and similar results are obtained after BSI Z-score correction for age. A lower significance (T-test p = 0.0281) is found for DXA T-score.

The 8 fractured oncological patients exhibit significantly lower values of BSI T-score that the oncological population (T-test p = 0.038) and all patients have a BSI T-score indicative of a compromised trabecular structure. DXA T-score values cannot be considered statistically different (T-test p = 0.6744) and results span all possible diagnostic results from high risk to normal.

Conclusions

Statistical analyses show that bone micro-architecture is indeed affected by oncological treatment and that bone alterations due to oncological treatment are easily detected with BESTEST, especially when associated with fractures.

This preliminary study clearly provides a rational background for further, deeper investigations into the use of a new, rapid and safe technique for monitoring the effect of breast and prostate cancers therapies on bone micro-architecture modifications.

Citation Format: Cosmi F, Del Conte A, Foltran L, Nicolosi A, Saracchini S. New diagnostic tools for bone health assessment: Perspectives in medical oncology [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-03-08.