Clinical and molecular characteristics of 42 Danish patients with metastatic ALK fusion-positive lung cancer treated with first-line alectinib: A nationwide study

PURPOSE: We investigated whether EML4-ALK fusions and mutations in pre-treatment plasma ctDNA predicted time to treatment discontinuation (TTD) in ALK-positive non-small cell lung cancer (ALK+ NSCLC) patients initiating first-line alectinib and evaluated clinical characteristics influencing TTD.

MATERIALS & METHODS: 42 patients from five Danish public oncology departments with previously untreated, metastatic ALK+ NSCLC were included in the study. All patients received alectinib, a second-generation ALK inhibitor, as their first-line treatment. Clinical characteristics were obtained from the patients' health records. Plasma samples were collected before treatment start and analyzed with next-generation sequencing (NGS) analysis with the AVENIO ctDNA Surveillance kit.

RESULTS: We demonstrate that alectinib is effective regardless of baseline brain metastases, EML4-ALK variant type and co-mutations. The entire cohort had a median TTD for alectinib of 35.1 months (95% CI: 10.2-52). TTD for patients with baseline brain metastasis (BM) had a median of 34.4 months (95% CI:4.1- "not estimated" (NE)), whereas patients with no BM at baseline had a median of 16.9 months (95% CI: 4.6-NE). Additionally, 57% of the cohort were smokers, and the median TTD was shorter in smokers (11.2 months) than in never-smokers (52.0 months).

CONCLUSION: In incurable ALK+ NSCLC, alectinib appears effective as first-line therapy regardless of brain metastases. EML4-ALK fusions occur in smokers, and smoking may reduce TTD. These findings, limited by the small cohort, require confirmation in larger studies but may still help guide treatment predictions and strategies.