Real-World Treatment Patterns and Sequencing of ALK-Inhibitors in ALK-Positive NSCLC Treated with Palliative Intent
5 affiliations
- 1Karl Landsteiner Institute of Lung Research and Pulmonary Oncology and Department of Respiratory and Critical Care Medicine, Clinic Floridsdorf, Vienna Healthcare Group, 1210 Vienna, Austria
- 2Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, 1210 Vienna, Austria
- 3Karl Landsteiner Institute of Lung Research and Pulmonary Oncology and 2(nd) Department of Internal Medicine with Pulmonology, Clinic Ottakring, Vienna Healthcare Group, 1160 Vienna, Austria
- 4Ludwig Boltzmann Institute for Lung Health and Department of Respiratory and Pulmonary Diseases, Clinic Hietzing, Vienna Healthcare Group, 1130 Vienna, Austria
- 5Ludwig Boltzmann Institute for Lung Health and Department of Respiratory and Pulmonary Diseases, Site Penzing of Clinic Ottakring, Vienna Healthcare Group, 1140 Vienna, Austria
Abstract
Background: ALK-rearranged non-small cell lung cancer (NSCLC) is a molecularly defined subtype that is highly sensitive to ALK tyrosine kinase inhibitors (ALK inhibitors). With multiple generations of ALK inhibitors available, real-world data on treatment patterns and sequencing in routine clinical practice remain limited. Methods: This retrospective multicenter registry analysis included patients with ALK-positive NSCLC treated with palliative intent and enrolled in the LALUCA registry between November 2020 and September 2025 at four lung cancer centers in Vienna. ALK alterations were confirmed by next-generation sequencing. Demographic, clinical, and treatment-related data were analyzed descriptively. Results: Twenty-eight patients were included (median age, 54 years [range, 26–84]; 46.4% female). Most patients had stage IV disease (85.7%) and adenocarcinoma histology (92.9%). Overall, 49 systemic treatment lines were administered, including 41 ALK inhibitor treatment lines (22 second-generation and 19 third-generation). At data cut-off, 39.0% of ALK inhibitor treatment lines were ongoing, with a higher proportion of ongoing treatment observed among third-generation compared with second-generation ALK inhibitors (52.6% vs. 27.3%). The Kaplan–Meier-estimated median treatment duration was 287 days (95% CI, 172-NE) for second-generation and 736 days (95% CI, 376–NE) for third-generation ALK inhibitors. Objective response rates were 77.3% and 73.7%, respectively. Adverse events of any grade occurred in 73.2% of treatment lines, while grade ≥ 3 adverse events occurred in 12.2%. Dose reductions and temporary treatment interruptions were used to manage toxicity and allowed for treatment continuation in most affected treatment lines. Conclusions: This multicenter real-world analysis provides insights into contemporary ALK inhibitor treatment patterns and sequencing in routine clinical practice. Third-generation ALK inhibitors were associated with longer observed treatment durations in this cohort, although these findings should be interpreted cautiously given the small sample size, retrospective analysis, and potential differences in treatment selection and follow-up. Overall, toxicity was generally manageable, with dose modifications and temporary treatment interruptions frequently allowing for continuation of ALK inhibitor therapy.
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BibTeX
@article{ay2026realworld,
title = {{Real-World Treatment Patterns and Sequencing of ALK-Inhibitors in ALK-Positive NSCLC Treated with Palliative Intent}},
author = {Leyla Ay and Julie Krainer-Jacobs and Anna Lang-Stöberl and Vania Mikaela Rodriguez and Hannah Fabikan and Christoph Weinlinger and Maximillian Johannes Hochmair and Nino Müser and Robab Breyer-Kohansal and Marie-Kathrin Breyer and Arschang Valipour},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18213470},
url = {https://www.mdpi.com/2072-6694/18/21/3470},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Real-World Treatment Patterns and Sequencing of ALK-Inhibitors in ALK-Positive NSCLC Treated with Palliative Intent
AU - Leyla Ay
AU - Julie Krainer-Jacobs
AU - Anna Lang-Stöberl
AU - Vania Mikaela Rodriguez
AU - Hannah Fabikan
AU - Christoph Weinlinger
AU - Maximillian Johannes Hochmair
AU - Nino Müser
AU - Robab Breyer-Kohansal
AU - Marie-Kathrin Breyer
AU - Arschang Valipour
PY - 2026
DA - 2026/10/27
JO - Cancers
DO - 10.3390/cancers18213470
UR - https://www.mdpi.com/2072-6694/18/21/3470
AB - Background: ALK-rearranged non-small cell lung cancer (NSCLC) is a molecularly defined subtype that is highly sensitive to ALK tyrosine kinase inhibitors (ALK inhibitors). With multiple generations of ALK inhibitors available, real-world data on treatment patterns and sequencing in routine clinical practice remain limited. Methods: This retrospective multicenter registry analysis included patients with ALK-positive NSCLC treated with palliative intent and enrolled in the LALUCA registry between November 2020 and September 2025 at four lung cancer centers in Vienna. ALK alterations were confirmed by next-generation sequencing. Demographic, clinical, and treatment-related data were analyzed descriptively. Results: Twenty-eight patients were included (median age, 54 years [range, 26–84]; 46.4% female). Most patients had stage IV disease (85.7%) and adenocarcinoma histology (92.9%). Overall, 49 systemic treatment lines were administered, including 41 ALK inhibitor treatment lines (22 second-generation and 19 third-generation). At data cut-off, 39.0% of ALK inhibitor treatment lines were ongoing, with a higher proportion of ongoing treatment observed among third-generation compared with second-generation ALK inhibitors (52.6% vs. 27.3%). The Kaplan–Meier-estimated median treatment duration was 287 days (95% CI, 172-NE) for second-generation and 736 days (95% CI, 376–NE) for third-generation ALK inhibitors. Objective response rates were 77.3% and 73.7%, respectively. Adverse events of any grade occurred in 73.2% of treatment lines, while grade ≥ 3 adverse events occurred in 12.2%. Dose reductions and temporary treatment interruptions were used to manage toxicity and allowed for treatment continuation in most affected treatment lines. Conclusions: This multicenter real-world analysis provides insights into contemporary ALK inhibitor treatment patterns and sequencing in routine clinical practice. Third-generation ALK inhibitors were associated with longer observed treatment durations in this cohort, although these findings should be interpreted cautiously given the small sample size, retrospective analysis, and potential differences in treatment selection and follow-up. Overall, toxicity was generally manageable, with dose modifications and temporary treatment interruptions frequently allowing for continuation of ALK inhibitor therapy.
SN - 2072-6694
ER -