Around 2% of patients with non-small cell lung cancer have changes in the anaplastic lymphoma kinase (ALK) gene which may make the cancer cells grow faster.
Researchers from the MCRC, a partnership between The University of Manchester, The Christie NHS Foundation Trust and Cancer Research UK, looked at crizotinib – a drug that targets ALK gene abnormalities. In previous small studies the drug had shown activity in patients with lung cancer who have the defective ALK gene – ‘ALK-positive’ patients.
Dr Fiona Blackhall, a clinician from The University of Manchester’s Institute of Cancer Sciences and a consultant based at The Christie, said: “Until now researchers had very little information about the effectiveness of standard chemotherapy on ALK-positive patients though there was some suggestion that they may be more sensitive to some types of chemotherapy. In order to be able to offer patients the most effective therapies we need to carry out large trials that compare how well patients with specific subtypes of disease do on different treatments.”
The study, published in the New England Journal of Medicine, involved 347 ALK-positive patients who had previously received chemotherapy for their disease. It showed that those who received treatment with crizotinib did better than those given standard chemotherapy. They had a longer time when their cancer remained stable and did not get worse. They also had less symptoms and reported a better quality of life. In addition, more patients given crizotinib responded to treatment.
Dr Blackhall added: “These were patients who had metastatic disease that had spread to other parts of the body. Crizotinib achieved a 50% reduction in patients’ risk of progression which is considerable in this group of patients. Symptoms such as hair loss, shortness of breath, fatigue and pain in the chest, arm, shoulder or other parts of the body were also reduced with crizotinib, and there was a greater delay in symptoms getting worse. “
As part of the study, funded by Pfizer, patients were asked to complete questionnaires specially developed to assess their quality of life. Those receiving crizotinib reported improved quality of life and better functioning generally compared with standard chemotherapy. The researchers are now waiting for more mature data from the study to see whether crizotinib also improves overall survival.
“The study shows that crizotinib is better than standard chemotherapy in this patient population. Around 1,600 people are diagnosed with non-small cell lung cancer in Greater Manchester every year and about 2 % of these will be ALK-positive – these are the patients who may benefit from targeted therapy rather than standard chemotherapy. The study findings have the potential to change the way we treat patients with ALK-positive advanced non-small cell lung cancer,” said Dr Blackhall.
Notes for editors
For further information, please contact Alison Barbuti, The University of Manchester, 0161 275 8383.
*Annual average number of cases of trachea, bronchus and lung cancer (C33-C34) diagnosed in Greater Manchester Metropolitan County 2008-2010 is 2,100 cases. Source: These data were extracted from the UK Cancer Information Service, version 4.5b 001 on 16/07/2013. Of these around 78% will be non-small cell lung cancer, about 1,600 cases.
The study was published in the New England Journal of Medicine in June last year. Shaw AT et al. Crizotinib versus chemotherapy in advanced ALK-positive lung cancer. N Engl J Med 2013;368:2385–94. The results were also presented at the European Cancer Congress 2013 (ECCO-ESMO-ESTRO); Impact of crizotinib on patient-reported symptoms and global quality of life (QoL) compared with chemotherapy in a phase III study of advanced alk-positive non-small cell lung cancer (NSCLC), Blackhall et al.