Efficacy and Safety of Brigatinib Compared With Crizotinib in Asian vs. Non-Asian Patients With Locally Advanced or Metastatic ALK-Inhibitor-Naive ALK plus Non-Small Cell Lung Cancer: Final Results From the Phase III ALTA-1L Study

Abstract

We evaluated brigatinib efficacy and safety compared with crizotinib in an analysis of Asian (n = 108) and non -Asian (n = 167) subgroups from the phase III ALTA-1L study. Brigatinib showed better BIRC-assessed PFS over crizotinib in Asians and non-Asians (HR [95% CI], log-rank: Asians, 0.35 [0.20-0.59], P = .0 0 01; non-Asians, 0.56 [0.38-0.84], P = .0041). Overall safety was similar between groups. Background: Brigatinib is a next-generation anaplastic lymphoma kinase (ALK) inhibitor with demonstrated efficacy in locally advanced and metastatic non-small cell lung cancer (NSCLC) in crizotinib-refractory and ALK inhibitor-naive settings. This analysis assessed brigatinib in Asian vs. non-Asian patients from the first-line ALTA-1L trial. Patients and Methods: This was a subgroup analysis from the phase III ALTA-1L trial of brigatinib vs. crizotinib in ALK inhibitor-naive ALK+ NSCLC. The primary endpoint was progression-free survival (PFS) as assessed by blinded independent review committee (BIRC). Secondary endpoints included confirmed objective response rate (ORR) and overall survival (OS) in the overall population and BIRC-assessed intracranial ORR and PFS in patients with brain metastases. Results: Of the 275 randomized patients, 108 were Asian. Brigatinib showed consistent super ior ity in BIRC-assessed PFS vs. crizotinib in Asian (hazard ratio [HR]: 0.35 [95% CI: 0.20-0.59]; log-rank P = .0001; median 24.0 vs. 11.1 months) and non-Asian (HR: 0.56 [95% CI: 0.38-0.84]; log-rank P = .0041; median 24.7 vs. 9.4 months) patients. Results were consistent with investigator-assessed PFS and BIRC-assessed intracranial PFS. Brigatinib was well tolerated. Toxicity profiles and dose modification rates were similar between Asian and non-Asian patients. Conclusion: Efficacy with brigatinib was consistently better than with crizotinib in Asian and non-Asian patients with locally advanced or metastatic ALK inhibitor -naive ALK-+ NSCLC. There were no clinically notable differences in overall safety in Asian vs. non-Asian patients.