1371P First-line alectinib vs. brigatinib in advanced metastatic NSCLC with ALK rearrangement: Real-world data

Alectinib and brigatinib are second-generation anaplastic lymphoma receptor tyrosine kinases (ALKs) that are widely used as first-line therapy for treating ALK-positive advanced non-small cell lung cancer (NSCLC). Given the lack of a head-to-head comparison of these drugs as first-line therapies, this retrospective observational study aimed to compare the real-world efficacy and safety of alectinib and brigatinib. Patients who received alectinib or brigatinib as the first-line treatment for ALK-positive advanced NSCLC were evaluated for clinical outcomes of objective response rate (ORR), intracranial ORR, time to next treatment (TTNT), progression-free survival (PFS), overall survival (OS), and safety profiles. Of 208 patients who received either alectinib or brigatinib as a first-line treatment, 176 received alectinib and 32 received brigatinib. At the data cutoff point, the median follow-up duration was 10.6 months (95% CI: 9.7–11.5) in the brigatinib group and 24.6 months (95% CI: 19.4–29.9) in the alectinib group. The ORR was 91.9% with alectinib and 92.2% for brigatinib (p-value: 0.54, 95% CI: 0.35–7.30); the intracranial ORR rates were 94.6% and 100%, respectively. The rate of progression-free survival at 12 months was comparable between the alectinib group and the brigatinib group (84.8% vs. 84.1%, p-value: 0.93), and the median TTNT, PFS, and OS were not reached in either group. Treatment-related adverse events were usually mild, and treatment discontinuation due to adverse events was rare in both groups. Alectinib and brigatinib had similar clinical benefits when used as the first-line treatment of NSCLC patients with ALK rearrangement in the real world.