Characteristics of central nervous system progression in non-small cell lung cancer treated with crizotinib or alectinib.
Adult
Aged
Aged, 80 and over
Anaplastic Lymphoma Kinase
/ metabolism
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Carbazoles
/ administration & dosage
Carcinoma, Non-Small-Cell Lung
/ drug therapy
Central Nervous System Neoplasms
/ drug therapy
Crizotinib
/ administration & dosage
Female
Follow-Up Studies
Humans
Lung Neoplasms
/ drug therapy
Male
Middle Aged
Neoplasm Recurrence, Local
/ drug therapy
Piperidines
/ administration & dosage
Prognosis
Retrospective Studies
Survival Rate
Young Adult
CNS metastases
alectinib
crizotinib
non-small cell lung cancer
Journal
Cancer reports (Hoboken, N.J.)
ISSN: 2573-8348
Titre abrégé: Cancer Rep (Hoboken)
Pays: United States
ID NLM: 101747728
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
revised:
25
03
2021
received:
15
01
2021
accepted:
15
04
2021
pubmed:
8
5
2021
medline:
8
3
2022
entrez:
7
5
2021
Statut:
ppublish
Résumé
Most patients treated with anaplastic lymphoma kinase (ALK)-tyrosine kinase inhibitors for ALK-positive non-small cell lung cancer (NSCLC) develop resistance, leading to metastasis, with progression to the central nervous system (CNS) being a primary concern. Although alectinib has better CNS penetration than crizotinib, patients treated with alectinib also develop CNS progression. CNS metastases more likely occurs during crizotinib treatment due to less blood-brain barrier (BBB) penetration capability than alectinib. CNS progression pattern may be different during crizotinib and alecitinib treatment. Understanding the characteristics of CNS progression is important for developing treatment strategies. We compared the clinical-radiographic characteristics of CNS metastases among patients undergoing crizotinib and alectinib treatment for ALK-positive NSCLCs. We retrospectively analyzed the radiographic and clinical characteristics of CNS progression in ALK-positive NSCLC patients treated with crizotinib or alectinib at our hospital between July 2011 and May 2020. CNS and systemic tumor progression were evaluated using computed tomography or magnetic resonance imaging. Fifty-three and 65 patients were treated with crizotinib and alectinib, respectively. Baseline CNS metastasis was observed in 18 and 27 patients in the crizotinib and alectinib groups, respectively. Among the patients in the crizotinib and alectinib groups who developed disease progression, 15/49 (30.6%) and 9/44 (20.5%) had CNS progression, respectively (P = .344). Intra-CNS progression-free survival was significantly longer in the alectinib group than in the crizotinib group (median: 14.0 vs 5.6 months, P = .042). The number of CNS metastases sized ≥3 cm, rate of peritumoral brain edema, and the second progression pattern after treatment continuation was not significantly different between the groups. We observed no significant difference in the clinical-radiographic characteristics of CNS progression between patients undergoing crizotinib and alectinib treatments. Local therapy, including stereotactic radiosurgery, for CNS progression may be suitable and important following alectinib and crizotinib treatment.
Sections du résumé
BACKGROUND
Most patients treated with anaplastic lymphoma kinase (ALK)-tyrosine kinase inhibitors for ALK-positive non-small cell lung cancer (NSCLC) develop resistance, leading to metastasis, with progression to the central nervous system (CNS) being a primary concern. Although alectinib has better CNS penetration than crizotinib, patients treated with alectinib also develop CNS progression. CNS metastases more likely occurs during crizotinib treatment due to less blood-brain barrier (BBB) penetration capability than alectinib. CNS progression pattern may be different during crizotinib and alecitinib treatment. Understanding the characteristics of CNS progression is important for developing treatment strategies.
AIMS
We compared the clinical-radiographic characteristics of CNS metastases among patients undergoing crizotinib and alectinib treatment for ALK-positive NSCLCs.
METHODS AND RESULTS
We retrospectively analyzed the radiographic and clinical characteristics of CNS progression in ALK-positive NSCLC patients treated with crizotinib or alectinib at our hospital between July 2011 and May 2020. CNS and systemic tumor progression were evaluated using computed tomography or magnetic resonance imaging. Fifty-three and 65 patients were treated with crizotinib and alectinib, respectively. Baseline CNS metastasis was observed in 18 and 27 patients in the crizotinib and alectinib groups, respectively. Among the patients in the crizotinib and alectinib groups who developed disease progression, 15/49 (30.6%) and 9/44 (20.5%) had CNS progression, respectively (P = .344). Intra-CNS progression-free survival was significantly longer in the alectinib group than in the crizotinib group (median: 14.0 vs 5.6 months, P = .042). The number of CNS metastases sized ≥3 cm, rate of peritumoral brain edema, and the second progression pattern after treatment continuation was not significantly different between the groups.
CONCLUSION
We observed no significant difference in the clinical-radiographic characteristics of CNS progression between patients undergoing crizotinib and alectinib treatments. Local therapy, including stereotactic radiosurgery, for CNS progression may be suitable and important following alectinib and crizotinib treatment.
Identifiants
pubmed: 33960745
doi: 10.1002/cnr2.1414
pmc: PMC8714545
doi:
Substances chimiques
Carbazoles
0
Piperidines
0
Crizotinib
53AH36668S
ALK protein, human
EC 2.7.10.1
Anaplastic Lymphoma Kinase
EC 2.7.10.1
alectinib
LIJ4CT1Z3Y
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1414Subventions
Organisme : This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Informations de copyright
© 2021 The Authors. Cancer Reports published by Wiley Periodicals LLC.
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