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LETTER TO THE EDITOR
Year : 2019  |  Volume : 8  |  Issue : 4  |  Page : 211-225

Use of lorlatinib subsequent to crizotinib in anaplastic lymphoma kinase-positive non-small cell lung cancer: Indian experience


Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication22-Oct-2019

Correspondence Address:
Dr. Vanita Noronha
Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sajc.sajc_169_19

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How to cite this article:
Talreja VT, Noronha V, Joshi A, Patil V, Mahajan A, Prabhash K. Use of lorlatinib subsequent to crizotinib in anaplastic lymphoma kinase-positive non-small cell lung cancer: Indian experience. South Asian J Cancer 2019;8:211-25

How to cite this URL:
Talreja VT, Noronha V, Joshi A, Patil V, Mahajan A, Prabhash K. Use of lorlatinib subsequent to crizotinib in anaplastic lymphoma kinase-positive non-small cell lung cancer: Indian experience. South Asian J Cancer [serial online] 2019 [cited 2019 Dec 12];8:211-25. Available from: http://journal.sajc.org/text.asp?2019/8/4/211/269694

Dear Editor,

Lung cancer treatment is a rapidly evolving and an excellent example of precision medicine. The outcome of anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) has improved significantly with recent report showing the survival of 56% at 4 years.[1] This has been possible due to the availability of effective sequential treatment. One of the important drugs has been lorlatinib. This has found to be effective in second-line setting after crizotinib.[2] There has been no data from India. We retrospectively analyzed the data of patients receiving lorlatinib in our hospital. Patients diagnosed with ALK-positive advanced NSCLC who have received lorlatinib between January 2018 and February 2019 patients who have progressed on crizotinib were included in the study. Lorlatinib (Pfizer Oncology, Groton, CT, USA) was administered orally in a tablet form at a starting dose of 100 mg once daily continuously in 21-day cycles.

The details of these patients were obtained from the prospective lung cancer audit database that is maintained in the department of medical oncology. Demography (age, gender, comorbidity, and smoking status), disease status, and therapy details were recorded. ALK amplified status was ascertained either by immunohistochemistry (monoclonal antibody D5F3 [Ventana Medical Systems, Tucson, AZ, USA]) or fluorescent in situ hybridization analysis (Abbott Molecular platform). Response assessment was performed every 2–4 months as per the institutional practice and evaluated by RECIST 1.1 criteria. Toxicity during this period was evaluated in accordance with the Common Terminology Criteria for Adverse Events version 4.02 Lorlatinib (Pfizer Oncology, Groton, CT, USA). Date of disease progression, date of change in treatment, and date of death were recorded. SPSS version 21 was used for analysis, and response rate, progression-free survival (PFS), and overall survival were calculated.

[Table 1] and [Table 2] tabulate baseline characteristics and side effects of lorlatinib. The estimated median PFS in our study was 9.0 months (range: 5.6 months–12.3 months) [Figure 1]. Out of 9 evaluable patients, 2 (20%) and 5 (50%) has complete and partial responses, respectively [Table 1]. Our results are comparable to that reported in the literature.[2] However, median duration of response in our cohort was lesser (9 months) in comparison to that reported in literature (12.5 months). Reason for such discrepant data can be explained in view of lorlatinib used in those with extensive disease progressed on multiple lines of therapy and ongoing responses [Table 3].
Table 1: Baseline characteristics of patients treated with lorlatinib

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Table 2: Adverse effects of lorlatinib

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Figure 1: Median progression-free survival in patients on lorlatinib of 9.0 months (range: 5.6–12.3 months)

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Table 3: Patient-wise line therapy received with median progression-free survival

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We report clinical outcomes on patients with crizotinib-resistant disease treated with lorlatinib and find it an important new treatment option for those patients whose disease has progressed after treatment with crizotinib or second-generation ALK tyrosine kinase inhibitors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Solomon BJ, Kim DW, Wu YL, Nakagawa K, Mekhail T, Felip E, et al. Final overall survival analysis from a study comparing first-line crizotinib versus chemotherapy in ALK-mutation-positive non-small-cell lung cancer. J Clin Oncol 2018;36:2251-8.  Back to cited text no. 1
    
2.
Solomon BJ, Besse B, Bauer TM, Felip E, Soo RA, Camidge DR, et al. Lorlatinib in patients with ALK-positive non-small-cell lung cancer: Results from a global phase 2 study. Lancet Oncol 2018;19:1654-67. Erratum in: Lancet Oncol 2019;20:e10.  Back to cited text no. 2
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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