title: Alectinib in ALK-positive, crizotinib-resistant, non-small-cell lung cancer: a single-group, multicentre, phase 2 trial.
abstract: BACKGROUND
  Alectinib--a highly selective, CNS-active, ALK inhibitor-showed promising clinical activity in crizotinib-naive and crizotinib-resistant patients with ALK-rearranged (ALK-positive) non-small-cell lung cancer (NSCLC). We aimed to assess the safety and efficacy of alectinib in patients with ALK-positive NSCLC who progressed on previous crizotinib.
  
  
  METHODS
  We did a phase 2 study at 27 centres in the USA and Canada. We enrolled patients aged 18 years or older with stage IIIB-IV, ALK-positive NSCLC who had progressed after crizotinib. Patients were treated with oral alectinib 600 mg twice daily until progression, death, or withdrawal. The primary endpoint was the proportion of patients achieving an objective response by an independent review committee using Response Evaluation Criteria in Solid Tumors, version 1.1. Response endpoints were assessed in the response-evaluable population (ie, patients with measurable disease at baseline who received at least one dose of study drug), and efficacy and safety analyses were done in the intention-to-treat population (all enrolled patients). This study is registered with ClinicalTrials.gov, number NCT01871805. The study is ongoing and patients are still receiving treatment.
  
  
  RESULTS
  Between Sept 4, 2013, and Aug 4, 2014, 87 patients were enrolled into the study (intention-to-treat population). At the time of the primary analysis (median follow-up 4·8 months [IQR 3·3-7·1]), 33 of 69 patients with measurable disease at baseline had a confirmed partial response; thus, the proportion of patients achieving an objective response by the independent review committee was 48% (95% CI 36-60). Adverse events were predominantly grade 1 or 2, most commonly constipation (31 [36%]), fatigue (29 [33%]), myalgia 21 [24%]), and peripheral oedema 20 [23%]). The most common grade 3 and 4 adverse events were changes in laboratory values, including increased blood creatine phosphokinase (seven [8%]), increased alanine aminotransferase (five [6%]), and increased aspartate aminotransferase (four [5%]). Two patients died: one had a haemorrhage (judged related to study treatment), and one had disease progression and a history of stroke (judged unrelated to treatment).
  
  
  CONCLUSIONS
  Alectinib showed clinical activity and was well tolerated in patients with ALK-positive NSCLC who had progressed on crizotinib. Therefore, alectinib could be a suitable treatment for patients with ALK-positive disease who have progressed on crizotinib.
  
  
  BACKGROUND
  F Hoffmann-La Roche.
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA. Electronic address: ASHAW1@mgh.harvard.edu.
authors.forename: Alice T
authors.initials: AT
authors.lastname: Shaw
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Leena
authors.initials: L
authors.lastname: Gandhi
authors.affiliation: Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
authors.forename: Shirish
authors.initials: S
authors.lastname: Gadgeel
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Riely
authors.affiliation: Oregon Health and Sciences University, Portland, OR, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Cetnar
authors.affiliation: Swedish Cancer Center, Seattle, WA, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: West
authors.affiliation: University of Colorado, Boulder, CO, USA.
authors.forename: D Ross
authors.initials: DR
authors.lastname: Camidge
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Socinski
authors.affiliation: Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Chiappori
authors.affiliation: Florida Hospital Cancer Institute, Orlando, FL, USA.
authors.forename: Tarek
authors.initials: T
authors.lastname: Mekhail
authors.affiliation: Ohio State University, Columbus, OH, USA.
authors.forename: Bo H
authors.initials: BH
authors.lastname: Chao
authors.affiliation: Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Hossein
authors.initials: H
authors.lastname: Borghaei
authors.affiliation: M D Anderson Cancer Center, Houston, TX, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Gold
authors.affiliation: F Hoffmann-La Roche, Basel, Switzerland.
authors.forename: Ali
authors.initials: A
authors.lastname: Zeaiter
authors.affiliation: F Hoffmann-La Roche, Basel, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Bordogna
authors.affiliation: F Hoffmann-La Roche, Basel, Switzerland.
authors.forename: Bogdana
authors.initials: B
authors.lastname: Balas
authors.affiliation: F Hoffmann-La Roche, Basel, Switzerland.
authors.forename: Oscar
authors.initials: O
authors.lastname: Puig
authors.affiliation: F Hoffmann-La Roche, Basel, Switzerland.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Henschel
authors.affiliation: Chao Family Comprehensive Cancer Center, University of California, Irvine School of Medicine, Orange, CA, USA.
authors.forename: Sai-Hong Ignatius
authors.initials: SI
authors.lastname: Ou
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000077548:Anaplastic Lymphoma Kinase; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000097:blood; D002227:Carbazoles / Q000009:adverse effects / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000201:enzymology; D003248:Constipation / Q000139:chemically induced; D003402:Creatine Kinase / Q000097:blood; D000077547:Crizotinib; D019008:Drug Resistance, Neoplasm; D004487:Edema / Q000139:chemically induced; D005221:Fatigue / Q000139:chemically induced; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D063806:Myalgia / Q000139:chemically induced; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use*; D011720:Pyrazoles / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D020794:Receptor Protein-Tyrosine Kinases / Q000032:analysis / Q000037:antagonists & inhibitors; D066066:Response Evaluation Criteria in Solid Tumors; D019233:Retreatment
chemical_list: D000970:Antineoplastic Agents; D002227:Carbazoles; D010880:Piperidines; D011720:Pyrazoles; D011725:Pyridines; D000077547:Crizotinib; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D020794:Receptor Protein-Tyrosine Kinases; D003402:Creatine Kinase; C582670:alectinib