Evaluating ALK tyrosine kinase inhibitor drugs for elderly patients with non-small cell lung cancer

This study evaluated the effectiveness and safety of three different ALK tyrosine kinase inhibitors in patients with non-small cell lung cancer (NSCLC). The authors concluded that these inhibitors were similarly effective, but elderly patients over age 65 were more likely to develop side effects.

NSCLC is the most common type of lung cancer. About 3 to 5% of patients have a mutation in a gene called ALK. Cancer cells with this genetic mutation are sensitive to tyrosine kinase inhibitor (TKI) therapy. This type of treatment works inside cancer cells and blocks signals needed for tumors to grow. 

Crizotinib (Xalkori), ceritinib (Zykadia) and alectinib (Alecensa) are three common TKI therapies for patients with NSCLC that have the ALK mutation. Previous studies examined how effective these agents are for younger patients (under age 65). However, whether ALK TKI therapy is safe and effective for elderly patients is unclear. 

This study included records from 53 patients with NSCLC with the ALK mutation. Patients were divided into two groups based on age. Group A had 34 patients under age 65 and Group B had 19 patients aged 65 or older. Patients received crizotinib, ceritinib, and/or alectinib. Patients were followed-up for an average of 15.1 months to 24.4 months. 

Overall, patients survived for an average of 29.8 months (Group A) and 25.1 months (Group B). For all patients, the average overall survival (time from treatment until death from any cause) was 26.1 months. Having 3 lines of ALK TKI therapy was significantly associated with a 94% lower mortality risk.

94% of group A and 100% of group B received crizotinib. On average, patients in Group B survived for slightly longer without tumor growth or spread compared to Group A (5.6 months vs. 5.4 months).

35% of group A and 31% of group B received ceritinib. On average, patients in Group B survived for longer without tumor growth or spread compared to Group A (23 months vs. 4.7 months).

58% of group A and 52% of group B received alectinib. On average, patients in Group A survived for longer without tumor growth or spread compared to Group B (21.2 months vs. 5.6 months). 

Overall, elderly patients age 65 or older (Group B) were more likely to experience side effects compared to younger patients (Group A). The most common side effects were fatigue, diarrhea, and nausea.

This study concluded that ALK tyrosine kinase inhibitors were similarly effective in elderly patients and in patients under 65 with ALK-mutated NSCLC. However, elderly patients were more likely to experience side effects.

This study had a small number of patients and looked back in time to analyze data. Data was collected from cancer centers in Israel, so the results may not apply to all patients. More studies are needed to confirm these results.