Professor Li Xingya: Renewed! Bugatinib directly hit the brain, committed to the patient's survival time and quality of life improvement, with good safety characteristics to escort ALK-positive NSCLC patients

preface

The proposal of precision medicine has brought new ideas to the treatment of patients with advanced non-small cell lung cancer (NSCLC), and molecularly targeted therapy based on driving genes has become a successful example

With the prolongation of survival, ALK-positive NSCLC patients have entered the "era of chronic disease management", and the quality of life and safety of ALK-positive NSCLC patients have attracted more and more clinical attention

Expert Profiles

Professor Li Xingya

• Deputy Director and Chief Physician of the Oncology Department of Zhengda First Affiliated Hospital

  
  

• Professor, Ph.

  
  

• Henan Provincial Health Science and Technology Leading Talents

• Postdoctoral Fellow, University of Connecticut (2010-2013)

• CSCO Governor, Commissioner

• Chairman of the Lung Cancer Branch of Henan Respiratory and Critical Care Society

• Vice Chairman of the Tumor Professional Committee of Henan Medical Association

• Vice Chairman of chemotherapy professional committee of Henan Anti-Cancer Association

• Presided over the completion of a national natural science foundation of China

• He has supervised more than 40 doctors and masters

ALK-positive NSCLC quality of life status is worrying, brain metastases are the "culprit" of deterioration of quality of life

With the continuous development and application of ALK-TKI, the survival time of ALK-positive NSCLC patients has been greatly extended

In addition to the adverse effects of long-term medication, brain metastases are also one of the important factors affecting the quality of life of ALK-positive

Burgatinib "turned out", and the extension of survival time and the improvement of quality of life are both integrated

Brain metastases have been reported in 50% to 60% of patients after treatment with a generation ALK-TKI razotinib1

Figure 1: Alta-1L study of brain metastases subgroup PFS results

In terms of quality of life, boogetinib significantly improves health-related quality of life (HRQOL) to worsen over 18 months, and significantly improves the time to exacerbation in multiple dimensions, such as emotional function, social function, fatigue, gastrointestinal-related symptoms, etc

Figure 2: EORTC-QOL-C30 score degradation time

Burgettinib stands out and the safety data is encouraging

Studies have found that specific adverse reactions of anti-tumor drugs can affect the quality of life of patients and reduce patient adherence to treatment
.

Therefore, the selection of clinical antineoplastic drugs needs to pay attention to their safety ^{characteristics5}
.

Professor Li Xingya introduced that the overall safety data of burgettinib and other ALK-TKI were consistent, and there was no difference in
adverse events (AE) of any level.

Most of the adverse reactions reported by bugatinib are grade 1-2 and the safety is ^{controllable6}
.

Figure 3: Burgettinib security

Pay attention to elderly lung cancer populations, and prefer high-efficiency and low-toxicity treatment regimens

The wave of aging is coming, and the incidence of lung cancer in the elderly in China is high
.

Professor Li Xingya said that although ALK-positive patients are more common in young patients, there are also middle-aged and elderly ALK fusion-positive NSCLC patients
in the clinic.

There are many comorbidities in the elderly, such as cardiovascular and cerebrovascular diseases, liver and kidney insufficiency, etc
.

In addition, the social function and behavioral function of the elderly are not very good
.

Some elderly patients with brain metastases also have adverse reactions
such as mental decline, gastrointestinal reactions, and body language function effects after brain radiotherapy.

The long-term treatment of elderly lung cancer patients faces many difficulties and challenges, and clinical attention needs to be paid to elderly lung cancer patients
.

First-line treatment for elderly lung cancer patients requires the choice of drugs
that are safe and clinically more beneficial.

In addition, after the development of lung cancer "chronic disease", elderly lung cancer patients with comorbidities may need to take some drugs to treat chronic diseases in addition to anti-lung cancer drugs
during treatment.

In these cases, clinicians need to consider more factors (such as drug interactions), so multidisciplinary collaboration is important
.

In general, the combination of other underlying disease treatment drugs with anti-tumor drugs should be very cautious, Professor Li Xingya added
.

Gefibrozil (a potent CYP2 C8 inhibitor, hyperlipidemia) has shown no clinical significance on the pharmacokinetics of bufotinib when used in combination with bugotinib7
.

References:

1.
Zou Z, Xing P, Hao X, et al.
Intracranial efficacy of alectinib in ALK-positive NSCLC patients with CNS metastases—a multicenter retrospective study[J].
BMC medicine, 2022, 20(1): 1-13.

2.
Taylor-Stokes G, Wood R, Lees M, et al.
Impact of Brain Metastases on the Humanistic Burden Incurred by Patients with Advanced Non-small Cell Lung Cancer (A-nsclc)[C]//JOURNAL OF THORACIC ONCOLOGY, 2017, 12(11): S2072-S2072.

3.
Ma Chunhua, Jiang Rong.
Advances in the treatment of brain metastases in non-small cell lung cancer[J].
Chinese Journal of Lung Cancer, 2012, 15(5): 309.

4.
Camidge D R, Kim H R, Ahn M J, et al.
Brigatinib versus crizotinib in ALK inhibitor–naive advanced ALK-positive NSCLC: final results of phase 3 ALTA-1L trial[J].
Journal of Thoracic Oncology, 2021, 16(12): 2091-2108.

5.
Jiang Wenqi, Ba Yi, Feng Jifeng, et al.
Chinese Expert Consensus on the Prevention and Treatment of Nausea and Vomiting Related to Tumor Drug Therapy (2019 Edition)[J].
Chinese Journal of Frontiers in Medicine: Electronic Edition, 2019, 11(11): 16-26.

6.
Camidge D R, Kim H R, Ahn M J, et al.
Brigatinib versus crizotinib in advanced ALK inhibitor–naive ALK-positive non–small cell lung cancer: Second interim analysis of the phase III ALTA-1L trial[J].
Journal of Clinical Oncology, 2020, 38(31): 3592.

7.
Buatinib Instruction Manual (March 22, 2022)

Disclaimer: For use by healthcare professionals only for informational purposes
.

Such information should not in any way replace professional medical guidance and should not be considered a medical advice
.

If such information is used for purposes other than information, this site and the author do not assume relevant responsibility
.

Approval code: C-APROM/CN/ALUN/0340

Approval date: September 2022

Edit: AXZ

Typography: Uni

Execution: Small garden