Clinical Profile and Response to Crizotinib of ALK

positive Lung Cancer patients in INDIAN population

​Bamania A​1​,Sahni DS​1​,Mohan A​*​,Malik PS​+​, Madan K*, Hadda V*, Khilnani GC*, Guleria R*

*Department of Pulmonary Medicine and Sleep Disorders,All India Institute of Medical Sciences,India
+​
Dr BR Ambedkar Institute Rotary Cancer Hospital,All India Institute of Medical Sciences,India

RATIONALE
To examine the clinical profile and evaluate treatment response of advanced EML4-ALK positive
Non-small cell Lung Cancer (NSCLC) patients to Crizotinib in a tertiary care center of INDIAN
population with socio-economic constraints to the access to drug where only one previous study has
been done previously.

METHODS
A case series was formed by retrospective analysis of advanced ALK positive NSCLC patients who were
treated from August 2014 to October 2016.The primary goal was to examine the clinical profile of
advanced ALK positive NSCLC in our practice and study the treatment response to Crizotinib in a
developing country.

RESULTS
(A)Clinical Profile
21 patients were available for analysis.The cohort of patients belonged to age group 28-67years
(median=45 years).It was slightly male predominant(52.4%).The disease was found to be dominant in
non-smokers (80.96%).
Cough (76%) and dyspnea (67%) were the most common clinical symptoms observed.
42.86% of the patients had ECOG >=2.Majority of the patients had Stage IV disease (85.71%) with
Brain and Bone being the most common site for metasteses (44.44% each).Pleural Effusion was
observed in 61.11% patients.
(B)Treatment Response
3 (14.3%) patients were started on Crizotinib upfront,18 (85.7%) on chemotherapy along with
supportive care.Reasons for not starting Crizotinib upfront involved ALK not tested upfront and high
cost of Crizotinib.Crizotinib as second line therapy was given to 12 (57.1%) patients.
27.8% of patients responded(includes Stable Disease and Progressive Disease) to 1st​ ​ line
chemotherapy.Both the patients who received Crizotinib upfront developed Progressive
 ​ ​ line
Disease.44.4% of patients responded(includes Complete Response and Partial Response) to 2nd
Crizotinib.
Mean Progression Free Survival(PFS) for the entire cohort was 5.94months,with patients receiving
Crizotinib upfront having meanPFS of 6.96months and as 2nd ​ ​ line therapy of 8.9months.This was more
than the patients who received chemotherapy(4.32 months).
Overall Survival for the cohort which received Crizotinib was 13.64 months(1st​ ​ line therapy) and 8.27
​ ​ line therapy).
months (2nd

CONCLUSION
The use of Crizotinib in INDIA is limited due to high costs associated testing for ALK rearrangements
and high drug cost,hence apart from clinical efficacy,socioeconomic factors are a major determinant
in choice of drug in NSCLC patients.
ALK positive patients are non-smokers who exhibit Stage IV lung Cancer disease with metastases
common in brain and bone.
Crizotinib exposure at any point of time during treatment is associated with PFS higher than that of
chemotherapy.
Funding-The authors received no funding for this work
Competing Interests-The authors have declared that no competing interests exist.