In 3 % to 5 % of cases, lung cancer is associated with ALK rearrangement and can therefore be targeted with the ALK inhibitors crizotinib and ceritinib. While crizotinib is the standard first-line therapy, ceritinib has gained approval for use with patients who are crizotinib-refractory. Ceritinib showed clinical activity in both crizotinib-pretreated and ALK-inhibitor-naïve patients in the single-arm, multicentre, phase II, ASCEND-2 and ASCEND-3 studies [1, 2].
Park et al. presented a combined dataset at the ESMO Asia Congress from both of these studies for the patients with brain metastases at baseline . CNS metastases are a common complication in patients with ALK-positive NSCLC. Seventy-one percent and 40.3 % of the patients had brain lesions at the time of inclusion in ASCEND-2 and ASCEND-3, respectively. Prior radiotherapy to the brain had taken place in 72 % and 54 %, respectively.
At the established dose of 750 mg daily, the median PFS amounted to 6.8 months (ASCEND-2) and 11.0 months (ASCEND-3), by blinded independent central review. The ORRs (as the whole-body response) across these trials were 32.0 % and 60.0 %, respectively. In the patients with active brain lesions selected as the target lesions (e.g., those that progressed following local therapy), the overall intracranial response rates were 39.4 % and 58.8 %, respectively. The intracranial disease control rates exceeded 80 % in both trials.
The safety profile for patients with brain metastases did not differ from that in the overall patient population. This subgroup analysis shows that ceritinib is feasible in patients with brain metastases, as durable intracranial responses can be expected.