ALK Inhibitors in Patients With ALK Fusion-Positive GI Cancers: An International Data Set and a Molecular Case Series.

Purpose: In GI cancers, anaplastic lymphoma kinase ( ALK ) rearrangements are extremely less frequent than in non-small-cell lung cancer but may be important to offer personalized strategies of treatment in selected patients. Data about the activity and efficacy of ALK inhibitors (ALKi) in GI cancers are scarce.
Materials and Methods: We assembled a clinical and molecular international data set of pretreated patients with metastatic or nonresectable cancers of GI primary tumor origin with documented ALK rearrangement treated with at least one line of ALKi. Measurable disease as per RECIST 1.1 was required for response analysis.
Results: Primary tumor sites were distributed as follows: 5 (38%) pancreas, 3 (23%) right colon, and 1 (8%) for each one of gastric, duodenal, rectal, left colon, and biliary tract sites. Seven patients (54%) were treated with alectinib, 5 (38%) with crizotinib, and 1 (8%) with entrectinib. After disease progression, five patients (38%) received a subsequent ALKi treatment line, and at the time of data cutoff date, treatment was still ongoing in two patients. Five of 12 evaluable patients (41%) achieved a partial response to first-line ALKi, five patients (41%) had stable disease, and 2 (17%) had progressive disease. No complete responses were registered. At a median follow-up of 39.6 months (interquartile range: 19.8-59.5), the median progression-free survival was 5.0 months (95% CI, 3.68 to no response) and the median overall survival was 9.3 months (95% CI, 5.46 to no response).
Conclusion: Treatment with ALKi provides remarkable responses and clinical benefit in pretreated patients with ALK fusion-positive GI malignancies. Despite the rarity, ALK rearrangements represent an important therapeutic target in individual pretreated patients with GI solid tumors. Further work providing prospective clinical validation of this target is needed.
Competing Interests: Marzia Del ReConsulting or Advisory Role: Sanofi, Celgene, Janssen-Cilag, Ipsen, Roche Molecular DiagnosticsSpeakers' Bureau: Sanofi, Pfizer, Novartis, Janssen-Cilag, Ipsen, AstraZeneca, Astellas Pharma, Roche, MSD Oncology Paolo MancaPatents, Royalties, Other Intellectual Property: I have a patent for a method for the identification of gene panels optimal for TMB estimation (Inst) Andrew HendifarConsulting or Advisory Role: Novartis, Ipsen, Perthera, Celgene, AbbVie, EisaiResearch Funding: Ipsen, NGM Biopharmaceuticals (Inst)Travel, Accommodations, Expenses: HalozymeOther Relationship: FibroGen Alexander DrilonHonoraria: Pfizer, Loxo/Bayer/Lilly, IASLCConsulting or Advisory Role: Ignyta, Loxo, AstraZeneca, Pfizer, Blueprint Medicines, Genentech/Roche, BeiGene, Hengrui Therapeutics, Exelixis, Bayer, Tyra Biosciences, Takeda/Millennium, BerGenBio, MORE Health, Lilly, AbbVie, 14ner Oncology/Elevation Oncology, Monopteros Therapeutics, Novartis, EMD Serono/Merck, Repare Therapeutics, Melendi, Archer, Nuvalent Inc, Janssen, Amgen, Merus, Axis Pharma, Medscape, Liberum, Med Learning, PeerView, EPG Health, JNCCN/Harborside, Ology, Clinical Care Options, touchIME, Entos, Treeline, Prelude Therapeutics, Applied Pharmaceutical Science IncSpeakers' Bureau: Helsinn Therapeutics, Beigene, Remedica Ltd, TP Therapeutics, Verastem, Ignyta/Genentech/Roche, AstraZeneca, Liberum, Loxo/Bayer/Lilly, Lungevity, NIH, PER, OncLive/MJH Life Sciences, Clinical Care Options/NCCN, Lung Cancer Canada, AIOT, Chugai Pharma, Chugai Pharma, Sirio Libanes Hospital, Answers in CME, Faculty RTP, RV MoreResearch Funding: Foundation MedicinePatents, Royalties, Other Intellectual Property: Wolters Kluwer (Royalties for Pocket Oncology)Other Relationship: Merck, GlaxoSmithKline, Teva, Taiho Pharmaceutical, Pfizer, PharmaMar, Puma Biotechnology, Merus, Boehringer Ingelheim Guilherme HaradaSpeakers' Bureau: MSD, AstraZeneca, Pfizer Anne Hansen ReeHonoraria: MSD Oncology, BMSiResearch Funding: BMSi (Inst) Samuel KlempnerStock and Other Ownership Interests: TP Therapeutics, Nuvalent IncHonoraria: NateraConsulting or Advisory Role: Lilly, Astellas Pharma, Bristol Myers Squibb, Pieris Pharmaceuticals, Merck, Daiichi Sankyo/UCB Japan, Sanofi/Aventis, MersanaResearch Funding: Leap Therapeutics (Inst), BeiGene (Inst), Silverback Therapeutics (Inst)Other Relationship: NCCN Gunhild Mari MælandsmoPatents, Royalties, Other Intellectual Property: Patent application submitted for a nine-protein/gene panel predicting response to anti VEGF therapies in combination with chemotherapy (Inst) Hege G. RussnesHonoraria: AstraZeneca (Inst), Pfizer (Inst), InCyte (Inst), Merck (Inst), Roche (Inst)Research Funding: Foundation Medicine (Inst) James M. ClearyHonoraria: Blueprint Medicines, Syros PharmaceuticalsConsulting or Advisory Role: Bristol Myers SquibbResearch Funding: Merck, Tesaro, AstraZeneca, Esperas Pharma, AbbVie (Inst), Merus (Inst), Roche/Genentech (Inst), BMS (Inst)Travel, Accommodations, Expenses: Roche, Agios, Bristol Myers Squibb Andrea Sartore-BianchiConsulting or Advisory Role: Amgen, Bayer, Sanofi, Servier, Novartis Maria Di BartolomeoHonoraria: Lilly, MSD Oncology, Servier, BMSiConsulting or Advisory Role: Lilly, MSD OncologyResearch Funding: LillyTravel, Accommodations, Expenses: Roche, Sanofi Filippo PietrantonioHonoraria: Servier, Bayer, AstraZeneca/MedImmune, Lilly, Sanofi, MSD Oncology, AmgenConsulting or Advisory Role: Amgen, Servier, MSD Oncology, MerckResearch Funding: Bristol Myers Squibb (Inst), Astrazeneca (Inst)No other potential conflicts of interest were reported.