title: Treatment patterns and survival in patients withALK-positive non-small-cell lung cancer: a Canadian retrospective study.
abstract: BACKGROUND
  Crizotinib was the first agent approved for the treatment of anaplastic lymphoma kinase (ALK)-positive (+) non-small-cell lung cancer (nsclc), followed by ceritinib. However, patients eventually progress or develop resistance to crizotinib. With limited real-world data available, the objective of the present work was to evaluate treatment patterns and survival after crizotinib in patients with locally advanced or metastaticALK+ nsclc in Canada.
  
  
  METHODS
  In this retrospective study at 6 oncology centres across Canada, medical records of patients with locally advanced or metastaticALK+ nsclc were reviewed. Demographic and clinical characteristics, treatments, and outcomes data were abstracted. Analyses focused on patients who discontinued crizotinib treatment.
  
  
  RESULTS
  Of the 97 patients included, 9 were crizotinib-naïve, and 39 were still receiving crizotinib at study end. The 49 patients who discontinued crizotinib treatment were included in the analysis. Of those 49 patients, 43% received ceritinib at any time, 20% subsequently received systemic chemotherapy only (but never ceritinib), and 37% received no further treatment or died before receiving additional treatment. Median overall survival from crizotinib discontinuation was shorter in patients who did not receive ceritinib than in those who received ceritinib (1.7 months vs. 20.4 months,p< 0.001). In a multivariable analysis, factors associated with poorer survival included lack of additional therapies (particularly ceritinib), male sex, and younger age, but not smoking status; patients of Asian ethnicity showed a nonsignificant trend toward improved survival.
  
  
  CONCLUSIONS
  A substantial proportion of patients withALK+ nsclc received no further treatment or died before receiving additional treatment after crizotinib. Treatment with systemic agents was associated with improved survival, with ceritinib use being associated with the longest survival.
authors.affiliation: icon Health Economics and Epidemiology, Vancouver, BC.
authors.forename: S
authors.initials: S
authors.lastname: Kayaniyil
authors.affiliation: Novartis Pharmaceuticals Canada, Dorval, QC.
authors.forename: M
authors.initials: M
authors.lastname: Hurry
authors.affiliation: icon Health Economics and Epidemiology, Vancouver, BC.
authors.forename: J
authors.initials: J
authors.lastname: Wilson
authors.affiliation: Ottawa Hospital Research Institute, and Department of Medicine, University of Ottawa, Ottawa, ON.
authors.forename: P
authors.initials: P
authors.lastname: Wheatley-Price
authors.affiliation: Division of Medical Oncology, University of British Columbia, Vancouver, BC.
authors.forename: B
authors.initials: B
authors.lastname: Melosky
authors.affiliation: rsm Durham Regional Cancer Centre, Lakeridge Health, Oshawa, ON.
authors.forename: J
authors.initials: J
authors.lastname: Rothenstein
authors.affiliation: Department of Oncology, Jewish General Hospital, Montreal, QC.
authors.forename: V
authors.initials: V
authors.lastname: Cohen
authors.affiliation: Novartis Pharmaceuticals Canada, Dorval, QC.
authors.forename: C
authors.initials: C
authors.lastname: Koch
authors.affiliation: Novartis Pharmaceutical Corporation, East Hanover, NJ, U.S.A.
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.affiliation: icon Health Economics and Epidemiology, Vancouver, BC.
authors.forename: K
authors.initials: K
authors.lastname: Osenenko
authors.affiliation: Princess Margaret Cancer Centre, Toronto, ON.
authors.forename: G
authors.initials: G
authors.lastname: Liu
keywords: ALK-positive non-small-cell lung cancer; Crizotinib; ceritinib; lung cancer; survival; treatment patterns