ALK Translocated Non-Small Cell Lung Cancer: Experience from an Australian metropolitan tertiary referral centre. — ASN Events
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ALK Translocated Non-Small Cell Lung Cancer: Experience from an Australian metropolitan tertiary referral centre. (#367)

Malinda Itchins 1 , Kate Sinn 1 , David Chan 1 , Megan Crumbaker 1 , Anthony Gill 1 , Stephen Clarke 1 2 , Nick Pavlakis 1 2
  1. University of Sydney, Sydney, NSW, Australia
  2. Northern Cancer Institute, Sydney, NSW, Australia

Background:
The lower north shore of Sydney has a low rate of smoking at 10% and a high prevalence of patients of Asian background. The incidence of ALK positive non-small cell lung cancer (NSCLC) has been evaluated to be 4% of amongst all lung cancer cases. Care is provided across co-located public and private services. Reflex ALK testing using immunohistochemistry (IHC) has been undertaken by PaLMS – Pacific Laboratory Medicine Services (Pathology North ) since January 2012. All IHC positive cases are referred for florescence in situ hybridization (FISH) testing. Crizotinib, a proven effective targeted therapy was not PBS approved until July 1, 2015.

Aim:
To review and report an Australian metropolitan centre (Royal North Shore Hospital (RNSH) and Northern Cancer Institute) experience with this rare and unique cancer group.

Methods:
Pathology department data-base identification of ALK positive lung cases and retrospective chart review.

Results:
Between January 1 2012 and July 30 2015 thirty five ALK IHC positive cases were identified, 18 females, 17 males; 21 Caucasian, 12 Asian, 1 Indian and 1 Pacific-Islander. The median age was 62 years, range 25 to 84. All IHC positive cases were confirmed positive by FISH. 18 (51%) of these patients were treated on one or more first and second line clinical trials at RNSH evaluating crizotinib, alectanib or brigatinib. Other therapies included platinum/pemetrexed chemotherapy, surgery and radiotherapy as clinically indicated. Patient demographics, patterns of disease presentation and clinical course, treatment summary and completed clinical outcomes will be summarized and reported, for example we have found one in two patients have brain metastases at diagnosis. At data cut 29% of patients have died.

Conclusions:
The incidence of ALK positive NSCLC in our setting in the lower north shore of Sydney is 4%, in keeping with the range described in the literature. Patient inclusion on clinical trials was high reflecting strong willingness to participate and comply in order to access the most appropriate targeted therapies.

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