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Brigatinib and Alectinib for ALK Rearrangement-Positive Advanced Non-Small Cell Lung Cancer with or without Central Nervous System Metastasis: A Systematic Review and Network Meta-Analysis

1
Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
2
Advanced Cancer Translational Research Institute (Formerly, Institute of Molecular Oncology), Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(4), 942; https://doi.org/10.3390/cancers12040942
Received: 27 February 2020 / Revised: 27 March 2020 / Accepted: 9 April 2020 / Published: 10 April 2020
To date, no head-to-head trials have compared the efficacy of brigatinib and alectinib against anaplastic lymphoma kinase (ALK) rearrangement-positive (ALK-p), ALK-inhibitor-naïve, advanced non-small cell lung cancer (NSCLC) with central nervous system (CNS) metastasis. We conducted an indirect treatment comparison (ITC) between brigatinib and alectinib, with crizotinib as a common comparator, using a Bayesian model with non-informative prior distribution and assessed the between-study heterogeneity of the studies. The primary efficacy endpoint was progression-free survival (PFS), and efficacy was ranked using the surface under the cumulative ranking (SUCRA) curve values. ITC analysis showed that there were no significant differences in PFS between the brigatinib and alectinib arms. However, the SUCRA values revealed that alectinib ranked the highest by efficacy in the overall patient population, whereas brigatinib ranked the highest by efficacy in the CNS metastasis sub-group. Although there were no significant differences in the incidence of G3–5 adverse events between the brigatinib and alectinib arms in the overall patient population, the data were deemed insufficient for the CNS metastasis sub-group analysis. This study provides critical information to clinicians regarding the efficacy of brigatinib for ALK-p, ALK-inhibitor-naïve, advanced NSCLC patients, with and without CNS metastasis. Larger randomized, controlled trials are warranted to confirm our results. View Full-Text
Keywords: alectinib; ALK rearrangement; brigatinib; central nervous system metastasis; indirect treatment comparison; NSCLC; progression-free survival; systematic review alectinib; ALK rearrangement; brigatinib; central nervous system metastasis; indirect treatment comparison; NSCLC; progression-free survival; systematic review
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MDPI and ACS Style

Ando, K.; Akimoto, K.; Sato, H.; Manabe, R.; Kishino, Y.; Homma, T.; Kusumoto, S.; Yamaoka, T.; Tanaka, A.; Ohmori, T.; Sagara, H. Brigatinib and Alectinib for ALK Rearrangement-Positive Advanced Non-Small Cell Lung Cancer with or without Central Nervous System Metastasis: A Systematic Review and Network Meta-Analysis. Cancers 2020, 12, 942. https://doi.org/10.3390/cancers12040942

AMA Style

Ando K, Akimoto K, Sato H, Manabe R, Kishino Y, Homma T, Kusumoto S, Yamaoka T, Tanaka A, Ohmori T, Sagara H. Brigatinib and Alectinib for ALK Rearrangement-Positive Advanced Non-Small Cell Lung Cancer with or without Central Nervous System Metastasis: A Systematic Review and Network Meta-Analysis. Cancers. 2020; 12(4):942. https://doi.org/10.3390/cancers12040942

Chicago/Turabian Style

Ando, Koichi; Akimoto, Kaho; Sato, Hiroki; Manabe, Ryo; Kishino, Yasunari; Homma, Tetsuya; Kusumoto, Sojiro; Yamaoka, Toshimitsu; Tanaka, Akihiko; Ohmori, Tohru; Sagara, Hironori. 2020. "Brigatinib and Alectinib for ALK Rearrangement-Positive Advanced Non-Small Cell Lung Cancer with or without Central Nervous System Metastasis: A Systematic Review and Network Meta-Analysis" Cancers 12, no. 4: 942. https://doi.org/10.3390/cancers12040942

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