Patients diagnosed with stage IV non-small cell lung cancer (NSCLC) from 2009 to 2017 lived for 6.8 years later and had survival of 50 percent compared to only 2 percent survival in patients form 1995 to 2001.

‘Better survival rates of patients with stage IV disease are attributed to improved targeted therapies available in recent times.’

Of the 110 patients on the current study, 83 percent were never-smokers, and had a median age of 53 years. Almost all of these patients were initially treated with the drug crizotinib, which earned FDA approval in August 2011 to treat ALK+ NSCLC, but had previously been available in Colorado and other academic medical centers in the setting of clinical trials. Importantly, after treatment with crizotinib, when patients on the current study showed evidence of worsening disease, 78 percent were transitioned to another ALK-inhibitor, commonly brigatinib, alectinib or ceritinib. 




"Many studies have reported shorter overall survival for patients with stage IV ALK+ NSCLC treated with crizotinib. These studies had lower survival outcomes in large part because of a lower percentage of patients receiving next-gen ALK inhibitors after progressing on crizotinib. Patients here were getting next-gen ALK inhibitors in phase 1 and 2 clinical trials before many other centers had access to them," Pacheco says.
Another factor that influenced survival was the use of pemetrexed-based chemotherapies in ALK+ lung cancer. Often, in addition to targeted therapy with ALK inhibitors, patients will undergo chemotherapy (and sometimes radiation). However, there are many chemotherapies to choose from, and it is often unclear which specific chemotherapies are most successful with specific cancers, stages, and patient characteristics. A 2011 study by CU Cancer Center investigator D. Ross Camidge, MD, PhD, who is also senior author of the current study, suggested that pemetrexed works especially well against the ALK+ form of the disease.
"We try to use mainly pemetrexed-based chemotherapies in ALK+ lung cancer," Pacheco says, "It is possible shorter survival in other studies may be associated with use of non-pemetrexed based chemotherapies."
Interestingly, the existence of brain metastases at time of diagnosis did not predict shorter survival.
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The most predictive factor of shorter survival was the number of organs that were found to carry cancer at the time of diagnosis.
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Source-Eurekalert