Crizotinib versus conventional chemotherapy in first-line treatment for ALK-positive non-small cell lung cancer : a systematic review and meta-analysis

Cruz, Barbara D. and Barbosa, Mariana M. and Torres, Lucas L. and Azevedo, Pamela S. and Silva, Vânia E. A. and Godman, Brian and Alvares-Teodoro, Juliana (2021) Crizotinib versus conventional chemotherapy in first-line treatment for ALK-positive non-small cell lung cancer : a systematic review and meta-analysis. Oncology and Therapy. ISSN 2366-1070

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    Abstract

    Background: Lung cancer is the most incident type and the main cause of death from malignant neoplasms worldwide. One of the most recent discoveries in the context of Non-Small Cell Lung Cancer (NSCLC) was the mutation of the anaplastic lymphoma kinase receptor (ALK). This genetic alteration is found in approximately 2% to 5% of NSCLC patients, and crizotinib was the first target therapy discovered for its first-line treatment. Objective: Conduct a systematic review and meta-analysis, to estimate the magnitude of the overall survival (OS) and progression free survival (PFS) from using crizotinib as treatment compared to traditional chemotherapy to guide future decision making. Methods: PRISMA and COCHRANE recommendations were followed using the findings based on published in the main international electronic databases. Selection criteria included: Randomized Clinical Trials (RCT) or cohort studies and had assessed the efficacy and effectiveness of crizotinib as monotherapy in patients with NSCLC with ALK fusions Results: From 2504 publications identified in the literature, only 8 publications referring to 7 studies met the selection criteria with high heterogeneity identified between the studies. Overall, there was a significant gain on PFS (HR 0.38; 95% CI: 0.30 - 0.49; p <0.00001), however, there was no significant gain on OS (HR 0.68; 95% CI: 0.43 - 1.08; p = 0.10). Conclusion: The study highlighted and confirmed that crizotinib showed clinical improvement on the PFS of patients with advanced NSCLC with ALK fusion, as previously reported. However, there was no increase in overall survival in patients with NSCLC with genetic alterations of ALK. This must be considered when reviewing and funding treatments of NSCLC patients with this mutation.