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