A Real-World Study: Therapeutic Outcomes of ROS1-Positive Advanced NSCLC

Area of Science:

• Oncology
• Genetics
• Pharmacology

Background:

• ROS1 gene rearrangement is a key therapeutic target in non-small cell lung cancer (NSCLC).
• Limited real-world data exists on ROS1 diagnostic methods, treatment selection, and outcomes in the Chinese population.

Purpose of the Study:

• To analyze trends in ROS1 testing methods and treatment strategies for ROS1-positive advanced NSCLC in China.
• To evaluate the efficacy and resistance patterns of ROS1 inhibitors in a real-world setting.

Main Methods:

• Retrospective analysis of ROS1-positive advanced NSCLC patients treated between July 2011 and November 2021.
• Documentation of ROS1 testing methods (FISH vs. NGS), initial treatment choices (TKI vs. chemotherapy), efficacy, and resistance mechanisms.

Main Results:

• ROS1 testing evolved from FISH to NGS, with a significant increase in NGS use post-2019.
• First-line ROS1-TKI use rose significantly, with crizotinib being the primary choice (90%), achieving an 82.8% objective response rate and 18.7 months median PFS.
• Central nervous system (CNS) progression was common (60%) with crizotinib; rebiopsy revealed G2032R as the most frequent secondary mutation (48.3% of resistant cases).

Conclusions:

• Advancements in diagnostics and therapeutics, alongside expanded insurance coverage, are improving patient outcomes for ROS1-positive NSCLC.
• While crizotinib shows efficacy, improved CNS protection strategies are needed.
• Emphasis on increasing rebiopsy rates in clinical practice is crucial for managing resistance.