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Open Access 01-12-2021 | NSCLC | Research

Comparative efficacy and safety of first-line treatments for advanced non-small cell lung cancer with ALK-rearranged: a meta-analysis of clinical trials

Authors: Hao-chuan Ma, Yi-hong Liu, Kai-lin Ding, Yu-feng Liu, Wen-jie Zhao, Yan-juan Zhu, Xue-song Chang, Ya-dong Chen, Zhen-zhen Xiao, Ya-ya Yu, Rui Zhou, Hai-bo Zhang

Published in: BMC Cancer | Issue 1/2021

Abstract

Background

Whereas there are many pharmacological interventions prescribed for patients with advanced anaplastic lymphoma kinase (ALK)- rearranged non-small cell lung cancer (NSCLC), comparative data between novel generation ALK-tyrosine kinase inhibitors (TKIs) remain scant. Here, we indirectly compared the efficacy and safety of first-line systemic therapeutic options used for the treatment of ALK-rearranged NSCLC.

Methods

We included all phase 2 and 3 randomised controlled trials (RCTs) comparing any two or three treatment options. Eligible studies reported at least one of the following outcomes: progression free survival (PFS), overall survival (OS), objective response rate (ORR), or adverse events of grade 3 or higher (Grade ≥ 3 AEs). Subgroup analysis was conducted according to central nervous system (CNS) metastases.

Results

A total of 9 RCTs consisting of 2484 patients with 8 treatment options were included in the systematic review. Our analysis showed that alectinib (300 mg and 600 mg), brigatinib, lorlatinib and ensartinib yielded the most favorable PFS. Whereas there was no significant OS or ORR difference among the ALK-TKIs. According to Bayesian ranking profiles, lorlatinib, alectinib 600 mg and alectinib 300 mg had the best PFS (63.7%), OS (35.9%) and ORR (37%), respectively. On the other hand, ceritinib showed the highest rate of severe adverse events (60%).

Conclusion

Our analysis indicated that alectinib and lorlatinib might be associated with the best therapeutic efficacy in first-line treatment for major population of advanced NSCLC patients with ALK-rearrangement. However, since there is little comparative evidence on the treatment options, there is need for relative trials to fully determine the best treatment options as well as the rapidly evolving treatment landscape.

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Title: Comparative efficacy and safety of first-line treatments for advanced non-small cell lung cancer with ALK-rearranged: a meta-analysis of clinical trials
Authors: Hao-chuan Ma
Yi-hong Liu
Kai-lin Ding
Yu-feng Liu
Wen-jie Zhao
Yan-juan Zhu
Xue-song Chang
Ya-dong Chen
Zhen-zhen Xiao
Ya-ya Yu
Rui Zhou
Hai-bo Zhang
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: NSCLC
Lung Cancer
Lung Cancer
CNS Metastasis
NSCLC
Lung Cancer
Alectinib
Brigatinib
Ceritinib
Crizotinib
Lorlatinib
Published in: BMC Cancer / Issue 1/2021
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-021-08977-0

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