Tony S.K. Mok, BMSc, MD, FRCP(C), FHKCP, FHKAM, FASCO, is chairman of the Department of Clinical Oncology and the Li Shu Fan Professor of Clinical Oncology at the Chinese University of Hong Kong

Dr Mok on Final OS Data From the ALEX Study Evaluating First-Line Alectinib in ALK+ NSCLC

“The message is not really the survival difference [between alectinib and crizotinib] but rather the number: the median OS [in the alectinib group] was 81 months. One other important message is that at 84 months, 48% of patients are still alive.”

Tony S.K. Mok, BMSc, MD, FRCP(C), FRCP(Edin), FHKCP, FHKAM(Medicine), FASCO, the Li Shu Fan Medical Foundation endowed Professor and Chairman of Department of Clinical Oncology at the Chinese University of Hong Kong, discussed final overall survival (OS) data for first-line alectinib (Alecensa) in patients with previously untreated, advanced 

-positive non–small cell lung cancer (NSCLC) from the phase 3 ALEX trial (NCT02075840).

After 7 years of follow-up, the data from the ALEX study are now more mature, Mok began by stating. Accordingly, final OS data were presented during 

, and showed that first-line alectinib induced a clinically meaningful OS benefit and duration of response (DOR) when compared with crizotinib (Xalkori) in this patient population, regardless of baseline central nervous system metastasis.

At a median follow-up of 53.5 months with alectinib and 23.3 months with crizotinib, the 7-year OS rates were 48.6% vs 38.2%, respectively. Furthermore, the median OS in the alectinib arm (n = 152) reached 81.1 months (95% CI, 62.3-not evaluable) vs 54.2 months (95% CI, 34.6-75.6) in the crizotinib arm (n = 151). This outcome is particularly promising when contrasted with the historical median OS of less than 1 year for patients with NSCLC before the introduction of molecular targeting, Mok noted. Additionally, the median duration of response was 42.3 months (95% CI, 31.3-51.3) with alectinib (n = 126) and 11.1 months (95% CI, 7.9-13.0) with crizotinib (n = 115) in patients with previously untreated disease.

Despite this outcome, Mok acknowledged that statistically, there was no measurable difference in OS between the alectinib and crizotinib groups. This lack of statistical significance was attributed to 2 primary factors: the crossover that occurred between the treatment arms and the fact that the study was not powered to demonstrate OS benefits.

Mok emphasized that the most important information derived from these data was not the statistical difference in OS outcomes between arms, but the numerical median OS survival achieved with alectinib. Overall, these data continue to support the use of alectinib as a standard of care in the first line for patients with advanced 

Videos

Tony S.K. Mok, BMSc, MD, FRCP(C), FRCP(Edin), FHKCP, FHKAM(Medicine), FASCO, shares final OS data from the phase 3 ALEX study in ALK-positive NSCLC.
 

Dr Mok on Choosing Between First-Line Therapies for BRAF-Mutant NSCLC

“Starting with the 2 targeted therapy [options], we have dabrafenib and trametinib. [The other combination] is encorafenib plus binimetinib. Both are similar, in a way. They’re from different companies, [and are] slightly different compounds molecularly; however, they actually [demonstrate] similar inhibition and clinical efficacy [outcomes]."

Tony S.K. Mok, BMSc, MD, FRCP(C), FHKCP, FHKAM, FASCO, chairman of the Department of Clinical Oncology and the Li Shu Fan Professor of Clinical Oncology at The Chinese University of Hong Kong, discussed the available frontline treatment options for patients with 

-mutant non–small cell lung cancer (NSCLC),  his approach to treatment decision-making for this patient population, and what the future may hold in terms of therapeutic developments.

There are 3 primary options for patients with 

-mutant NSCLC, Mok began. Two involve targeted therapy—specifically TKIs—and the third is the standard approach of immunotherapy combined with chemotherapy, he said.

Targeted therapy options include the combination of dabrafenib (Tafinlar) and trametinib (Mekinist), as well as encorafenib (Braftovi) plus binimetinib (Mektovi). These regimens are mechanistically similar to each other, though the individual drugs are produced by different manufacturers and exhibit slight molecular differences, according to Mok. Despite this, both combinations have been shown to produce comparable levels of pathway inhibition and demonstrate similar clinical efficacy, he noted.

Alternatively, there is growing interest in the combination of chemotherapy and immunotherapy for patients with 

-mutant disease, Mok emphasized. However, current data regarding the efficacy of chemoimmunotherapy in patients with 

 V600E mutations are limited and have not demonstrated convincing progression-free survival outcomes with this approach compared with standard targeted therapy regimens, he explained. In light of the available evidence, Mok concluded by sharing that his current preference is to use 1 of the 2 targeted therapy combinations in this patient population.


Tony S.K. Mok, BMSc, MD, FRCP(C), FHKCP, FHKAM, FASCO, discusses first-line treatment decision-making for patients with BRAF-mutant non–small cell lung cancer.

Tony S. K. Mok, MD, BMSc, FRCPC, FASCO, chairman, Department of Clinical Oncology, Li Shu Fan Professor of Clinical Oncology, The Chinese University of Hong Kong, previews discussion topics for the upcoming webinar hosted by 

 on the novel coronavirus 2019 (COVID-19).

A weekly webinar series on OncLive.com has brought together leading experts in thoracic oncology to discuss the management of patients with lung cancer during the COVID-19 pandemic.

This week, Mok will participate in the workshop and provide an international perspective on the subject.

During the live stream, Mok hopes that the discussion, led by Nathan Pennell, MD, PhD, of Cleveland Clinic, will shed light on the efforts that have been put in place by each country to fight the pandemic. Additionally, Mok hopes to hear from participants on ways to support healthcare providers during the pandemic.

Tony S. K. Mok, MD, BMSc, FRCPC, FASCO, previews discussion topics for the upcoming webinar hosted by OncLive on the novel coronavirus 2019 (COVID-19).

Tony S. K. Mok, MD, BMSc, FRCPC, FASCO

Articles

Dr Mok on Final OS Data From the ALEX Study Evaluating First-Line Alectinib in ALK+ NSCLC

Dr Mok on Choosing Between First-Line Therapies for BRAF-Mutant NSCLC

Dr. Mok Previews Discussion Topics for the Upcoming COVID-19 Webinar