Abstract
INTRODUCTION: EML4-ALK rearrangements represent an oncogenic driver alteration in 5% of NSCLC cases. We aim to better understand real-world treatment patterns and outcomes of ALK fusion-positive (ALK+) patients with advanced-stage NSCLC. METHODS: We performed a retrospective population-based chart review of ALK+ patients with locally advanced or metastatic NSCLC in British Columbia (BC), Canada. Patients diagnosed from January 2014 to May 2023 were identified through the BC Cancer Genetics Laboratory database, and data were collected up to December 2023. RESULTS: A total of 216 patients with stage IIIB, IIIC, or IV ALK+ lung NSCLC were identified. Median age was 60 (range: 24-91) years, 151 (68.9%) had never smoked, and 95 (43.9%) were Asian. The median overall survival was 49.4 months with median follow-up time of 55.4 months. Majority of the cohort (n = 198, 91.7%) received palliative systemic therapy, all of which included at least one ALK tyrosine kinase inhibitor (TKI). The most common first-line regimen was alectinib (n = 97, 49.0%) followed by crizotinib (n = 84, 42.4%); only four and one patient received lorlatinib and brigatinib first line, respectively. Alectinib was frequently prescribed overall, with 80.3% of patients receiving it in any treatment line. Time to treatment discontinuation was significantly longer (p < 0.0001) on first-line alectinib at 22.9 months as compared with 10.9 months for crizotinib. CONCLUSIONS: Patients with ALK+ advanced NSCLC in BC have durable responses to ALK TKIs. Despite approval of all ALK TKIs for first-line use since 2021, alectinib is largely the favored agent in BC. Further real-world investigations can refine treatment strategies and shape policies around ALK TKIs for patients with ALK+ NSCLC.