Real-world treatment patterns in stage III ALK+ NSCLC patients in China: A multicenter retrospective study.

Abstract

e20077 Background: Stage III non-small cell lung cancer (NSCLC) is highly heterogeneous and ALK+ patients (pts) lack of standard treatment model. Thus, there is a huge unmet need to understand real-world treatment patterns, and relationship to survival outcomes in stage III ALK+ NSCLC patients. Methods: This study is a multicenter retrospective study to assess the real-world treatment patterns and outcomes of Chinese patients with stage III ALK+ NSCLC. Treatment naïve stage III ALK+ NSCLC patients were included and assigned to cohort 1 (surgery) and cohort 2 (non-surgery). The primary endpoint is treatment pattern, secondary endpoints are progression-free survival, overall survival, and ALK testing rate at stage III. Results: Between July 2018 and June 2024, 254 pts were included from 23 centers in China, with 144 pts in C1 and 110 pts in C2. Median age was 57 years (range: 24-80), 96.1% were adenocarcinoma or adenosquamous carcinoma (adenocarcinoma: 94.5%, adenosquamous carcinoma: 1.6%). The testing rates for ALK at stage III were 84.6%. In Cohort 1, all 144 patients have received surgery and 23.6% (34/144) received neoadjuvant therapy. Of patients after surgery, 84.0% (121/144) further received adjuvant therapy, among which 40.5% (49/121) was targeted therapy. In Cohort 2, 45.5% (50/110) patients have received chemoradiotherapy (CRT), including 40.0% (20/50) concurrent CRT (cCRT) and 60.0% (30/50) sequential CRT (sCRT). For CRT patients, 64.0% (32/50) received consolidation therapy, with targeted therapy as the majority (96.9%, 31/32) (table). Furthermore, 54.5% (60/110) patients have received systemic therapy only, including 90.0% (54/60) targeted therapy or targeted combined therapy and 10.0% (6/60) chemotherapy or immunochemotherapy. As of January 1, 2025 (data cut-off), the median follow-up times were 34.8 months for C1, 31.0 months for C2. For pts in C1, the overall median PFS (mPFS) for C1 and C2 were 32.1 months (95% CI, 21.2-43.0) and 24.9 months (95% CI, 20.8-29.0), respectively. Median OS was not reached in either group. The 3-yr OS rate for C1 and C2 were 91.7% and 88.2%, respectively. Conclusions: This study presents the real-world treatment pattern for stage III ALK+ NSCLC in China, showing that treatment options for this subset are varied in clinical practice due to disease heterogeneity. Further survival correlations with different treatment patterns are ongoing. Treatment patterns in two cohorts. Cohort 1 (144 pts) Surgery only 19/144 (13.2) Neoadjuvant treatment → Surgery 4/144 (2.8) Surgery → Adjuvant treatment 91/144 (63.2) Neoadjuvant treatment → Surgery → Adjuvant treatment 30/144 (20.8) Cohort 2 (110 pts) CRT 50/110 (45.5) cCRT 20/50 (40.0) sCRT 30/50 (60.0) Systemic therapy only 60/110 (54.5) Note: data are presented as n/N (%) except specifically notified.