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Lancet. 2017 Mar 4;389(10072):917-929. doi: 10.1016/S0140-6736(17)30123-X. Epub 2017 Jan 24.

First-line ceritinib versus platinum-based chemotherapy in advanced ALK-rearranged non-small-cell lung cancer (ASCEND-4): a randomised, open-label, phase 3 study.

Author information

1
University Paris-Sud, Orsay, France; Institut Gustave Roussy, Villejuif, France. Electronic address: Jean-Charles.Soria@gustaveroussy.fr.
2
National Cancer Centre Singapore and Genome Institute of Singapore, Singapore.
3
Azienda Ospedale Perugia, Perugia, Italy.
4
Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China.
5
University Hospital Virgen del RocioDoce de Octubre, Universidad Complutense & CNIO, Madrid, Spain.
6
University Hospital Cologne, Cologne, Germany.
7
Songklanagarind Hospital, Songkla, Thailand.
8
State Pavlov Medical University, St Petersburg, Russia.
9
Az. Ospedaliera San Gerardo, Monza, Italy.
10
National Taiwan University Hospital, Taipei, Taiwan.
11
Respiratory Oncology Unit, Department of Respiratory and Critical Care Medicine, Otto-Wagner-Spital, Vienna, Austria.
12
CHU de LILLE, Lille, France.
13
Taipei Veterans General Hospital, Taipei, Taiwan.
14
Hôpital Albert Michallon, Grenoble, France.
15
University Hospital A Coruña, La Coruna, Spain.
16
Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
17
Novartis Pharma AG, Basel, Switzerland.
18
Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.

Abstract

BACKGROUND:

The efficacy of ceritinib in patients with untreated anaplastic lymphoma kinase (ALK)-rearranged non-small-cell lung cancer (NSCLC) is not known. We assessed the efficacy and safety of ceritinib versus platinum-based chemotherapy in these patients.

METHODS:

This randomised, open-label, phase 3 study in untreated patients with stage IIIB/IV ALK-rearranged non-squamous NSCLC was done in 134 centres across 28 countries. Eligible patients were assigned via interactive response technology to oral ceritinib 750 mg/day or platinum-based chemotherapy ([cisplatin 75 mg/m2 or carboplatin AUC 5-6 plus pemetrexed 500 mg/m2] every 3 weeks for four cycles followed by maintenance pemetrexed); randomisation was stratified by World Health Organization performance status (0 vs 1-2), previous neoadjuvant or adjuvant chemotherapy, and presence of brain metastases as per investigator's assessment at screening. Investigators and patients were not masked to treatment assignment. The primary endpoint was blinded independent review committee assessed progression-free survival, based on all randomly assigned patients (the full analysis set). Efficacy analyses were done based on the full analysis set. All safety analyses were done based on the safety set, which included all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT01828099.

FINDINGS:

Between Aug 19, 2013, and May 11, 2015, 376 patients were randomly assigned to ceritinib (n=189) or chemotherapy (n=187). Median progression-free survival (as assessed by blinded independent review committee) was 16·6 months (95% CI 12·6-27·2) in the ceritinib group and 8·1 months (5·8-11·1) in the chemotherapy group (hazard ratio 0·55 [95% CI 0·42-0·73]; p<0·00001). The most common adverse events were diarrhoea (in 160 [85%] of 189 patients), nausea (130 [69%]), vomiting (125 [66%]), and an increase in alanine aminotransferase (114 [60%]) in the ceritinib group and nausea (in 97 [55%] of 175 patients), vomiting (63 [36%]), and anaemia (62 [35%]) in the chemotherapy group.

INTERPRETATION:

First-line ceritinib showed a statistically significant and clinically meaningful improvement in progression-free survival versus chemotherapy in patients with advanced ALK-rearranged NSCLC.

FUNDING:

Novartis Pharmaceuticals Corporation.

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