Real world study of safety and efficacy of lorlatinib as second line and beyond in ALK-rearranged advanced non-small cell lung cancer patients in India – a multicentre chart review study (ROSELAND)

Background: Lorlatinib, an anaplastic lymphoma kinase (ALK)-inhibitor, is approved as frontline as well as subsequent line of therapy in ALK-rearranged advanced non-small cell lung cancer (NSCLC).There is limited literature about safety and efficacy of lorlatinib in Indian patients. Materials and methods:This was a retrospective multicentre study on patients with ALKrearranged advanced NSCLC received lorlatinib as second line and beyond between May 2017 and December 2021.ALK was tested either by immunohistochemistry or fluorescent in-situ hybridisation.Clinicopathologic features, treatment details, toxicity and outcomes were analysed.Results: A total of 38 patients were enrolled with a median age of 54 years (range: 30-72) and male: female ratio of 20:18.Fifteen (44%) patients had brain metastases at baseline.Lorlatinib use was -second line in 11 (29%), third line in 21 (55%) and fourth line in 4 (11%) of patients, respectively.The best radiologic response to lorlatinib was -complete response in 9 (24%), partial response in 17 (46%), stable disease in 9 (24%) and progressive disease in 2 (5%) of patients, respectively.After a median follow-up of 76.6 months (95% CI: 68.9-100), the median progression-free survival (PFS) of lorlatinib was not reached (95% CI: 24.3-not reached) and median overall survival (OS) of the whole cohort was 93.1 months (95% CI: 62-not reached).Both median PFS (p = 0.48) and median OS (p = 0.74) was similar between second line and later line use of lorlatinib.Thirty-three (87%) patients experienced treatment-related toxicity and six (16%) patients required dose modification. Conclusion:Lorlatinib was highly efficacious in terms of overall response rate, median PFS and median OS in this small real-world cohort of advanced ALK+ve NSCLC with a manageable safety profile.