The good news
The 7-year outcomes of the CROWN Trial were presented at the annual American Society of Clinical Oncology (ASCO) meeting.
Why it’s important
Lorlatinib is a third generation ALK-tyrosine kinase inhibitor (TKI, a targeted therapy). The CROWN study is a Phase 3 trial in which 296 ALK+ patients received either crizotinib, a first generation ALK-TKI, or lorlatinib. The initial results of the trial showed that lorlatinib was superior to crizotinib (Shaw A, New England Journal of Medicine, 2020) and it is FDA approved for the treatment of metastatic ALK+ NSCLC. The update presented at the ASCO meeting revealed that after 7 years of follow-up, the median time of disease control, or progression-free survival, was not yet reached for lorlatinib and was 9.1 months for the patients treated with crizotinib. At 7 years, 55% of the patients receiving lorlatinib still had no progression of their disease. Loratinib also demonstrated both superior control of existing brain metastases and a reduction in the eventual development of brain metastases. No new progression of brain metastases was reported after patients were on lorlatinib for the first 30 months.
What it means for patients
Lorlatinib is very effective in the treatment of patients with advanced ALK+ NSCLC. Of importance is its ability to control existing brain metastases and prevent the development of new central nervous system (CNS) disease. There were no new side effects of concern related to the longer time on treatment. Patients who required a reduction in the lorlatinib dose did just as well as those who tolerated the full dose. Patients should always discuss risks and benefits and options for treatment with their Oncologist.
What to look for
Now at 7 years, there is no doubt that the benefit of lorlatinib is substantial for most patients with ALK+ lung cancer. We must not rest on our laurels since the vast majority of patients are not ultimately cured. It will also be important to continue to develop ways to manage side effects associated with the treatment.
New research in overcoming resistance and novel approaches to treatment must continue until 100% of the patients are cured. LCRF is committed to fund research that will bring us closer to a cure