Ali Murat Tatli1, Perran Fulden Yumuk2, Buge Oz3, Ahmet Bilici4, Pınar Gursoy5, Erdem Goker5, Ahmet Sezer6, Ahmet Ozet7, Umut Demirci8, Emine Bozkurtlar9, Irem Hicran Ozbudak10, Deniz Nart11, Tugba Canpolat12, Nalan Akyurek13, Saadettin Kilickap14
1Department of Medical Oncology, Akdeniz University, Antalya, Turkey.
2Department of Medical Oncology, Marmara University, Istanbul, Turkey.
3Department of Pathology, Cerrahpasa University, Istanbul, Turkey.
4Department of Medical Oncology, Medipol University, Istanbul, Turkey.
5Department of Medical Oncology, Ege University, Izmir, Turkey.
6Department of Medical Oncology, Baskent University, Adana, Turkey.
7Department of Medical Oncology, Gazi University, Ankara, Turkey.
8Department of Medical Oncology, Dr.A.Y. Ankara Oncology Hospital, Ankara, Turkey.
9Department of Pathology, Marmara University, Istanbul, Turkey.
10Department of Pathology, Akdeniz University, Antalya, Turkey.
11Department of Pathology, Ege University, Izmir, Turkey.
12Department of Pathology, Baskent University, Adana, Turkey.
13Department of Pathology, Gazi University, Ankara, Turkey.
14Department of Medical Oncology, Hacettepe University, Ankara, Turkey.
Summary
Purpose: In the literature there are conflicting data about the treatment efficacy of anaplastic lymphoma kinase (ALK) translocation positive non-small cell lung cancer (NSCLC) patients according to ALK fusion variants. We aimed to study the impact of ALK fusion variants on the survival of first-line crizotinib-treated NSCLC patients.
Methods: 101 locally advanced or metastatic ALK positive NSCLC patients treated with first-line crizotinib between January 2013 and December 2019 were retrospectively evaluated. We studied ALK fusion variants in 38 of those patients with adequate tumor tissue with reverse transcription polymerase chain reaction (RT PCR). Patients having ALK fusion variant 1 (v1) and non-variant 1 (non-v1) were compared for survival and response to crizotinib.
Results: Median age was 52.5 years (range 35-74), and 22 of 38 patients were male (57.9%). EML-4 ALK v1 was seen in 26 patients (68.4%) and 12 were non-v1 (variant 3a/b in 6, and non-EML-4 ALK variants in 6 patients). Objective response rate was 60.5% in all patients, whereas it was 61.5% in v1 and 58.3% in non-v1 group. Median progression-free survival (PFS) and overall survival (OS) were similar. Median PFS was 13.1 months in v1, and 12.4 months in non-v1 (p=0.232). Median OS was 23.2 months in v1, and 19.4 months non-v1 (p=0.493).
Conclusion: ALK v1 and non-v1 patients had the same OS and PFS after first-line crizotinib treatment, however there was a trend for v1 group for better OS.
Key words: non-small cell lung cancer, crizotinib, ALK inhibitor, EML4-ALK fusions.
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