Key Takeaways
- An ongoing study found that 60% of lung cancer patients who took the drug Lorbrena were alive and disease-free after five years, compared with 8% of patients treated with Xalkori. .
- The CROWN study provides the longest progression-free survival outcomes ever recorded in patients with non-small cell lung cancer.
Lung cancer, which accounts for one in eight cancers worldwide, is the most commonly diagnosed cancer. Despite available treatment options, including surgery, chemotherapy, radiotherapy, and immunotherapy drugs, survival rates for patients with advanced lung cancer have been dismal.
However, Pfizer's lung cancer treatment is showing promising results. Results from a new clinical trial show that Lorbrena (lorlatinib) prevents the progression of lung cancer in patients with ALK-positive non-small cell lung cancer (NSCLC), a type of lung cancer that occurs when mutations in the ALK gene cause abnormal lung cell growth.
highest survival rate
Among 296 patients with ALK-positive lung cancer who participated in Pfizer's CROWN trial, Lorbrena was shown to reduce the risk of developing intracranial progression, the stage at which tumors begin to form in the brain, by 94%. This resulted in the longest progression-free survival ever recorded in NSCLC patients.
“After five years of follow-up, we have not reached the median progression-free survival rate. This means that 60% of patients are still receiving treatment. [Lorbrena] Keep trying.” Todd Bauer, M.D., study co-author and oncologist at Tennessee Medical Oncology in Nashville, told VeryWell.
Bauer said this is a “good problem to have” because patients continue to reap the benefits of their treatment.
Lorbrena is the only ALK tyrosine kinase inhibitor (TKI) to report a 5-year progression-free survival rate. ALK TKI, an anti-cancer drug, works by stopping proteins that cause abnormal growth of tumor cells. Other inhibitors, such as Xalkori (crizotinib), are effective for the first 12 months, but cancer typically progresses thereafter due to drug resistance and cancer mutations.
The most common side effects are manageable
Bauer said the two most common side effects of Lorbrena are hypercholesterolemia, which is high levels of cholesterol in the blood, and hypertriglyceridemia, which is high levels of triglycerides in the blood. Both can be managed using statins and fibrates.
Other common side effects of Lorbrena include:
- Swelling (edema) of the arms, legs, hands, and feet
- numbness
- getting fat
- Thinking problems, such as forgetfulness or confusion
- fatigue
- Difficulty breathing
- joint pain
- diarrhea
- mood swings
- cough
“Managing it requires lifestyle changes, wearing compression stockings and elevating your legs,” Bauer said.
In clinical practice, side effects may be managed by reducing the dose or suspending the drug.
“The standard dosage of Lorbrena is 100mg tablets once daily. And when the patient starts showing those symptoms, [side effects]You can introduce anything from 75 mg once a day up to 50 mg once a day,” Bauer said.
Data from the CROWN trial suggest that dose changes do not impair efficacy. There was no difference in median progression-free survival or intracranial response rate in patients whose dose was tapered within the first 16 weeks of initiation.
“Even at slightly lower doses, you still maintain the full efficacy of the drug,” Bauer said.
Lorbrena also prevents brain cancer
Brain metastases, which occur in approximately 25% of lung cancer patients at the time of diagnosis, generally carry a poor prognosis. However, the CROWN study found that Lorbrena was effective in preventing brain metastases. After five years, 92% of Lorbrena patients were brain cancer-free, while 21% of Xalkori patients were brain cancer-free.
For patients with existing brain metastases, 81% of patients taking Lorbrena developed no further brain cancer while taking Lorbrena, while all patients taking Xalkori had their cancer progress or discontinue the study within two years. .
Lorbrena was effective even in patients without brain metastases. Only 4 of 114 patients developed brain lesions during the first 16 months of treatment.
Who would be a good candidate for Lorbrena?
Lorbrena is currently approved in the United States for NSCLC in adults with ALK-positive tumors detected using an FDA-approved test on tissue samples. Bauer said there are other predictors of response, such as examining whether there is an exchange in the TP53 gene.
ALK-positive NSCLC is an aggressive cancer, but it is important to note that not all NSCLCs are ALK-positive. In fact, only 5% of NSCLC cases are ALK positive.
Because Lorbrena is an ALK inhibitor, it may not be an effective treatment for patients with NSCLC without ALK mutations or other forms of lung cancer. Patients with lung cancer should talk to their oncologist about ALK testing.
What this means to you
Lorbrena is currently approved in the United States for adult patients with NSCLC whose tumors are ALK positive. ALK positivity can be confirmed using an FDA-approved test. Ask your oncologist for more information.