By Ross Camidge, MD, PhD / June 1, 2013
Lung cancer patients taking crizotinib had four more months of progression free survival
(dailyRx News) Lung cancer is a very complex disease. Depending on the genetic make-up of the cancer cells, lung cancer can be many different diseases. And personalized therapy treats the defective genes individuals patients have.
Changes in one gene – anaplastic lymphoma kinase gene (ALK) – play a major role in the course of non-small cell lung cancer (NSCLC).
One medication that targets these genetic mistakes is Xalkori (crizotinib).
Recent research found that, compared to standard chemotherapy, crizotinib controlled lung cancer for almost four months longer, and tumors responded to the medication better than to chemotherapy alone.
Despite these achievements, the study did not show that patients lived longer when taking Xalkori instead of standard chemotherapy.
Scientists from around the world were involved in this phase III trial, including dailyRx Contributing Expert, D. Ross Camidge, MD, PhD, the director of the lung cancer clinical program at the University of Colorado Hospital in Aurora.
The trial involved 347 patients with advanced ALK-positive (abnormal ALK patterns) lung cancer. Participants had already had one round of chemotherapy using platinum-based agents.
Patients were randomly assigned to receive either crizotinib (250 mg twice daily) or intravenous chemotherapy with pemetrexed (brand name Alimta) or docetaxel.
Participants taking the crizotinib experienced nearly eight months before the disease got worse (progression-free survival), compared to three months of progression-free survival for patients taking chemotherapy.
More tumors responded to the crizotinib than to the chemotherapy (65 percent versus 20 percent).
Both regimens caused side effects, but patients taking crizotinib reported a greater improvement in quality of life.
Dr. Camidge explained the significance of this research. “As with other oncogene [ALK] addicted cancers, getting the right targeted drug to the right patient appears superior to standard chemotherapy. Here the control arm was either on two standard second line chemotherapies (docetaxel or pemetrexed), and this subgroup analysis confirms crizotinib’s superiority over each individually,” Dr. Camidge told dailyRx News.
“However, what was also very interesting was that while these were perceived to be equivalent chemotherapies in adenocarcinoma of the lung, in the ALK+ population, consistent with several prior reports, pemetrexed seems to have much greater activity than expected. The mechanistic basis for this observation, which may influence the choice of standard chemotherapy in this population when chemotherapy is used going forward, remains under investigation,” Dr. Camidge said.
This therapy has a hefty price tag, with 30 capsules of Xalkori (250 mg) costing about $5,600.
This study was published June 1 in The New England Journal of Medicine.
This research was supported by Pfizer, the maker of Xalkori. One of the authors reported a financial relationship with Boehringer Inglelheim.