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Characteristics of central nervous system progression in non-small cell lung cancer treated with crizotinib or

Hiroaki Sakamoto1,2, Noriko Yanagitani1, Ryo Manabe1

  • 1Department of Thoracic Medical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

Cancer Reports (Hoboken, N.J.)
|May 7, 2021
PubMed
Abstract

Insights

Patients with ALK-positive NSCLC treated with alectinib showed longer intra-CNS progression-free survival than those on crizotinib. However, clinical-radiographic characteristics of CNS progression were similar between the two treatments.

Area of Science:

  • Oncology
  • Pharmacology
  • Neurology

Background:

  • Anaplastic lymphoma kinase (ALK)-tyrosine kinase inhibitors (TKIs) are used for ALK-positive non-small cell lung cancer (NSCLC).
  • Resistance to ALK-TKIs often leads to metastasis, particularly to the central nervous system (CNS).
  • While alectinib has better CNS penetration than crizotinib, CNS progression still occurs in patients treated with both agents.

Purpose of the Study:

  • To compare the clinical-radiographic characteristics of CNS metastases in patients with ALK-positive NSCLC treated with crizotinib versus alectinib.
  • To understand potential differences in CNS progression patterns between these two ALK-TKI treatments.

Main Methods:

  • Retrospective analysis of radiographic and clinical data from ALK-positive NSCLC patients treated with crizotinib or alectinib.
  • Evaluation of CNS and systemic tumor progression using CT or MRI scans.
  • Comparison of progression rates, intra-CNS progression-free survival, and characteristics of CNS metastases between the two treatment groups.

Main Results:

  • Intra-CNS progression-free survival was significantly longer for alectinib (median 14.0 months) compared to crizotinib (median 5.6 months) (P=.042).
  • No significant differences were observed in the number of CNS metastases ≥3 cm, rate of peritumoral brain edema, or subsequent progression patterns.
  • Rates of CNS progression among patients with disease progression were 30.6% for crizotinib and 20.5% for alectinib (P=.344).

Conclusions:

  • Clinical-radiographic characteristics of CNS progression did not significantly differ between crizotinib and alectinib treatments.
  • Local therapies, such as stereotactic radiosurgery, may be important for managing CNS progression in patients treated with either alectinib or crizotinib.
Keywords:
CNS metastasesalectinibcrizotinibnon-small cell lung cancer

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