We believe that this attempt enables clinicians to choose appropriate treatment easier .
According to rapid development of chemotherapy in advanced non-small cell lung cancer ( NSCLC ) , the Japan Lung Cancer Society has been up date d its own guideline annually since 2010 .
Recently , we have had various types of chemotherapeutic drugs like kinase inhibitors or immune-checkpoint inhibitors .
Thus , the guideline proposes to categorize patients into three entities : ( 1 ) driver oncogene-positive , ( 2 ) PD-L1 ≥ 50 % , and ( 3 ) others .
Here , we report an English version of the Japan Lung Cancer Society Guidelines 2018 for NSCLC , stages IV
Alectinib versus Crizotinib in Untreated ALK‐Positive Non–Small‐Cell Lung Cancer
Background Alectinib , a highly selective inhibitor of anaplastic lymphoma kinase ( ALK ) , has shown systemic and central nervous system ( CNS ) efficacy in the treatment of ALK‐positive non – small‐cell lung cancer ( NSCLC ) . We investigated alectinib as compared with crizotinib in patients with previously untreated , advanced ALK‐positive NSCLC , including those with asymptomatic CNS disease . Methods In a r and omized , open‐label , phase 3 trial , we r and omly assigned 303 patients with previously untreated , advanced ALK‐positive NSCLC to receive either alectinib ( 600 mg twice daily ) or crizotinib ( 250 mg twice daily ) . The primary end point was investigator‐assessed progression‐free survival . Secondary end points were independent review committee – assessed progression‐free survival , time to CNS progression , objective response rate , and overall survival . Results During a median follow‐up of 17.6 months ( crizotinib ) and 18.6 months ( alectinib ) , an event of disease progression or death occurred in 62 of 152 patients ( 41 % ) in the alectinib group and 102 of 151 patients ( 68 % ) in the crizotinib group . The rate of investigator‐assessed progression‐free survival was significantly higher with alectinib than with crizotinib ( 12‐month event‐free survival rate , 68.4 % [ 95 % confidence interval ( CI ) , 61.0 to 75.9 ] with alectinib vs. 48.7 % [ 95 % CI , 40.4 to 56.9 ] with crizotinib ; hazard ratio for disease progression or death , 0.47 [ 95 % CI , 0.34 to 0.65 ] ; P<0.001 ) ; the median progression‐free survival with alectinib was not reached . The results for independent review committee – assessed progression‐free survival were consistent with those for the primary end point . A total of 18 patients ( 12 % ) in the alectinib group had an event of CNS progression , as compared with 68 patients ( 45 % ) in the crizotinib group ( cause‐specific hazard ratio , 0.16 ; 95 % CI , 0.10 to 0.28 ; P<0.001 ) . A response occurred in 126 patients in the alectinib group ( response rate , 82.9 % ; 95 % CI , 76.0 to 88.5 ) and in 114 patients in the crizotinib group ( response rate , 75.5 % ; 95 % CI , 67.8 to 82.1 ) ( P=0.09 ) . Grade 3 to 5 adverse events were less frequent with alectinib ( 41 % vs. 50 % with crizotinib ) . Conclusions As compared with crizotinib , alectinib showed superior efficacy and lower toxicity in primary treatment of ALK‐positive NSCLC . ( Funded by F. Hoffmann – La Roche ; ALEX Clinical Trials.gov number , NCT02075840 .
We believe that this attempt enables clinicians to choose appropriate treatment easier .
According to rapid development of chemotherapy in advanced non-small cell lung cancer ( NSCLC ) , the Japan Lung Cancer Society has been up date d its own guideline annually since 2010 .
Recently , we have had various types of chemotherapeutic drugs like kinase inhibitors or immune-checkpoint inhibitors .
Thus , the guideline proposes to categorize patients into three entities : ( 1 ) driver oncogene-positive , ( 2 ) PD-L1 ≥ 50 % , and ( 3 ) others .
Here , we report an English version of the Japan Lung Cancer Society Guidelines 2018 for NSCLC , stages IV