Evaluating crizotinib for patients with non-small cell lung cancer that has spread to the brain

This study evaluated how well crizotinib (Xalkori) works in patients with non-small cell lung cancer (NSCLC) with an ALK mutation that had spread to the brain. This study found that crizotinib treatment improved survival, but not for patients with cancer in the brain that continued to grow.

NSCLC is the most common type of lung cancer. Some patients with NSCLC have abnormal genes, which means that treatment can be different. About 5% of patients have a genetic mutation in a gene called ALK. Most patients with this genetic mutation experience tumor growth or spread, including to the brain.

Crizotinib is a treatment that targets cancer cells with this mutation. Crizotinib is a targeted therapy. This type of treatment specifically targets cancer cells and blocks their growth. This leads to cancer cell death. Whether crizotinib is effective for treating NSCLC that has spread to the brain remains unclear.

This study included 174 patients with NSCLC that was positive for the ALK mutation. 95 patients had cancer in the brain when the study started. 79 patients had cancer spread to the brain during treatment.  All patients were treated with crizotinib. Patients were followed for an average of 35.1 to 39.5 months.

Of those patients who already had cancer in the brain, 85.3% experienced tumor growth or spread. 58.9% had tumor growth or spread in the brain at an average of 19.3 months after treatment. On average, patients remained alive for 53.4 months after treatment (overall survival). 59.7% of patients were still alive 3 years later. At 5 years, this rate was 49.2%.

For patients who had cancer spread to the brain during treatment, the average overall survival was 42.3 months. 52.2% of patients were still alive 3 years later. At 5 years, this rate was 40.2%. Patients remained alive for an average of 28.5 months after the cancer spread.

Overall, 135 of all patients had the cancer in the brain grow while being treated. 94 patients continued treatment with crizotinib. These patients remained alive for an average of 48.3 months after treatment. Patients who did not continue treatment remained alive for an average of 53.4 months.

The study concluded that crizotinib does have some benefit for patients with NSCLC that has spread to the brain. The authors suggest that crizotinib may not improve long-term survival for patients who have continued tumor growth or spread in the brain.

This is a small study that looked back in time to analyze data. More studies are needed to confirm these results.