DOI: 10.1200/go-26-00042 ISSN: 2687-8941

Treatment of ALK+ Non–Small Cell Lung Cancer in the Brazilian Public and Private Health Care Systems: A Tale of Inequalities (LACOG/GBOT 1918)

Eldsamira Mascarenhas, Ana C. Z. Gelatti, Tatiane Montella, Marcelo Corassa, William N. William, Rosely Yamamura, Clarissa Baldotto, Eduardo H. Cronemberger, Aknar F. C. Calabrich, Giuliano S. Borges, Carlos H. A. Teixeira, Danielli Matias, Aline F. Fares, Cristina D. A. T. Sampaio, Antonia Angeli Gazola, Francisco de C. Zuanazzi, Paulo A. C. Schulze, Luísa M. T. Franche, Rafaela G. de Jesus, Juliana Giacomazzi, Matheus S. Rocha, Gustavo Gössling, Carlos G. Ferreira
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PURPOSE

ALK rearrangements occur in 5.4% of Brazilian patients with non–small cell lung cancer (NSCLC). Data on treatment patterns, access to ALK inhibitors, and survival outcomes are scarce.

MATERIALS AND METHODS

LACOG/GBOT 1918 is a retrospective, observational study that included patients diagnosed with ALK-positive NSCLC between January 2015 and December 2020 in 12 Brazilian public and private centers. Data were extracted from patient records, including clinic-epidemiologic features, diagnosis, ALK testing methods, treatment patterns, and outcomes. Data were analyzed using descriptive statistical methods.

RESULTS

A total of 101 patients were enrolled. The median age was 55 years (range, 18-86), and 55.4% were female. Immunohistochemistry was the most frequently used method for ALK testing. The median time from the first symptom to diagnosis was 2 months, from diagnosis to ALK testing 1.7 months, and from diagnosis to treatment initiation 1.7 months. Among patients receiving first-line treatment, only 47.9% received ALK inhibitors (53.9% private v 22.2% public), with crizotinib being the most used. For second-line treatment, 66.0% of patients received ALK inhibitors, with alectinib being the most used (50%). Most treated patients had access to ALK inhibitors in some line of treatment (83.3% private v 72.2% public); however, in the public setting, targeted treatment was restricted to first-generation and second-generation ALK inhibitors. The 3-year overall survival (OS) rate was 82.6% (95% CI, 72.6 to 89.2), with a lower 3-year OS in the public setting (61.4% public v 87.2% private; P = .0279).

CONCLUSION

Access to targeted ALK therapy is limited in the public health care system, reflecting poor clinical outcomes. Public health measures are necessary to minimize the differences between these two systems.

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