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Patient-Reported Outcomes From the CROWN Trial: First-Line Lorlatinib vs Crizotinib for ALK-Positive NSCLC


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Patient-reported outcomes from the phase III CROWN study showed that time to treatment deterioration in chest pain, dyspnea, and cough was comparable between those who received lorlatinib and patients who took crizotinib. The research was presented at the International Association for the Study of Lung Cancer (IASLC) 2020 World Conference on Lung Cancer (WCLC) Singapore, which was moved to a virtual format and held January 28–31, 2021, in light of the COVID-19 pandemic (Abstract MA11.08).

Lorlatinib, a third-generation ALK inhibitor, significantly improved progression-free survival compared to crizotinib in patients with previously untreated advanced ALK-positive NSCLC.

Julien Mazieres, MD, PhD, of Toulouse University Hospital, presented the detailed results of patient-reported outcomes from the CROWN trial.

Julien Mazieres, MD, PhD

Julien Mazieres, MD, PhD

Patient-Reported Outcomes

CROWN enrolled 296 patients with ALK-positive NSCLC and randomly assigned each to receive either lorlatinib or crizotinib. Patient-reported outcomes were assessed using the EORTC QLQ-C30 and QLQ-LC13, and the EQ-5D-5L. Each patient completed an assessment on the first day of each cycle (28 days) through end of treatment. Researchers measured time to treatment deterioration in chest pain, dyspnea, and cough, and compared these results between the two treatment arms.

Completion rates were 100% at baseline and remained high (≥ 96%) through cycle 18 in both treatment arms. There were no clinically meaningful or statistically significant differences between treatment arms in any functioning domain, with numerical improvements favoring lorlatinib in physical, role, emotional, and social functioning scales, and a numerical improvement favoring crizotinib for cognitive functioning.

According to Dr. Mazieres, there were statistically significant—but not clinically meaningful—differences favoring lorlatinib in symptoms of fatigue, nausea and vomiting, insomnia, appetite loss, and constipation. For diarrhea, there was both a clinically meaningful and statistically significant difference favoring lorlatinib. 

Lung cancer symptoms improved from baseline in both treatment arms, with clinically meaningful improvements in cough as early as cycle 2 and maintained through cycle 18. Time to treatment deterioration in the composite endpoint of lung cancer symptoms (cough, dyspnea, or chest pain) was similar between treatment arms (hazard ratio [HR] = 1.09, 95% confidence interval [CI] = 0.82–1.44, two-sided P = .5415). Median time to worsening of global quality of life was 24.0 months for lorlatinib and 12.0 months for crizotinib (HR = 0.92. 95% CI = 0.65–1.29). 

“Time to treatment deterioration for lung cancer symptoms was comparable between treatment arms. Improvements in lung cancer symptoms were seen early, and clinically meaningful improvements in cough were detected in [patients who received] lorlatinib,” reported Dr. Mazieres. “Patient-reported outcomes in [the] phase III CROWN [trial] support the improved progression-free survival and are consistent with safety/tolerability of lorlatinib relative to crizotinib.”

Disclosure: For full disclosures of the study authors, visit wclc2020.iaslc.org/disclosures.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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