ALK rearrangement testing and treatment patterns for patients with ALK-positive non-small cell lung cancer.
BACKGROUND
Approximately 2-8% of non-small cell lung cancer (NSCLC) patients have rearrangements in the anaplastic lymphoma kinase gene (ALK). ALK-targeted therapy is available to patients with tumors known to be ALK+. This chart review study described characteristics of patients with ALK+ NSCLC, patterns of ALK testing and subsequent treatments, and oncologists' experience with ALK testing in the US.


METHODS
US oncologists provided information in September and October of 2013 on patients from their practice diagnosed with ALK+ locally advanced or metastatic NSCLC, including the timing of ALK testing and treatment received after testing. Participating oncologists were also surveyed about their experience with ALK testing.


RESULTS
27 oncologists provided data on 273 ALK+ NSCLC patients. Patients' median age was 67 years upon NSCLC diagnosis. Smoking history varied, with 33% nonsmokers, 33% light smokers, and 33% heavy smokers. Patients were racially diverse: 59% White, 18% Black, 13% Asian, and 10% other. Upon diagnosis of advanced/metastatic NSCLC, patients who were either not tested (19%) or initially tested negative/inconclusive (1%) all received first-line chemotherapy; the other 219 patients (80%) tested positive, with 133 (61%) receiving an ALK inhibitor and 78 (29%) receiving chemotherapy as first-line treatment. Many oncologists stated being more likely to test for ALK rearrangements among Asians, nonsmokers, and light smokers.


CONCLUSIONS
In this sample, ALK+ NSCLC patients were racially diverse with mixed smoking history. One in five patients were not tested before first-line therapy. Oncologists reported being more likely to consider ALK testing for patients with particular smoking and race characteristics.
Group d'analyse, Ltée, Montréal, Quebec, Canada. Electronic address: aguerin@analysisgroup.com.
Annie
A
Guérin
Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
Medha
M
Sasane
Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
Jie
J
Zhang
Analysis Group, Inc., Boston, MA, USA.
Alexander R
AR
Macalalad
Analysis Group, Inc., Boston, MA, USA.
Philip
P
Galebach
Analysis Group, Inc., Boston, MA, USA.
John
J
Jarvis
Analysis Group, Inc., Boston, MA, USA.
Andrew
A
Kageleiry
Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
Kenneth
K
Culver
Analysis Group, Inc., Boston, MA, USA.
Eric Q
EQ
Wu
Stanford University School of Medicine, Palo Alto, CA, USA.
Heather
H
Wakelee
D000328:Adult; D000368:Aged; D000077548:Anaplastic Lymphoma Kinase; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000208:ethnology / Q000235:genetics*; D005260:Female; D015321:Gene Rearrangement; D005820:Genetic Testing / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000208:ethnology / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics*
D000970:Antineoplastic Agents; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D020794:Receptor Protein-Tyrosine Kinases
Anaplastic lymphoma kinase; Carcinoma, Non-small-cell lung; In situ hybridization, Fluorescence; Lung neoplasms