ALUR Trial: Alectinib and CNS Metastases in ALK-Positive NSCLC
Alectinib may significantly decrease central nervous system (CNS) disease progression in patients with previously treated ALK-positive non–small cell lung cancer (NSCLC), potentially preserving their neurocognitive capacity, according to the findings of the phase III ALUR trial, presented at the 2017 European Society for Medical Oncology (ESMO) Congress (Abstract 1299O_PR). According to lead study investigator Silvia Novello, MD, PhD, of the University of Turin, Italy, these results “support alectinib as a new standard of care for patients with previously treated ALK-positive NSCLC.”
The ALUR trial included 107 ALK-positive NSCLC patients whose disease had progressed after first-line combination treatment with platinum-based chemotherapy and crizotinib. Patients were subsequently randomized 2:1 to receive second-line therapy with alectinib (n=72) or standard relapse chemotherapy (n=35).
Median progression-free survival was longer with alectinib than chemotherapy: 9.6 versus 1.4 months. Among patients who had measurable CNS disease at baseline, the CNS overall response rate was 54.2% with alectinib, compared with 0% with chemotherapy (p<.001). Additionally, the safety profile of alectinib compared favorably with chemotherapy, despite its longer treatment duration: 20 weeks versus 6 weeks.
“A drug that has this activity on brain metastases can allow us to modify treatment and reduce the need for whole-brain radiotherapy,” added Dr. Novello in an ESMO press release.