Efficacy and Tolerability of Crizotinib in Metastatic Non-Small Cell Lung Cancer: A Real-World Algerian Study Highlighting Rare ALK/ROS1 Rearrangements and Therapeutic Implications.

Abstract

Background:

Anaplastic lymphoma kinase (ALK) and ROS1 gene rearrangements occur in 3–7% and 1–2% of non-small cell lung cancer (NSCLC) cases, respectively. Crizotinib, a first-generation oral inhibitor of ALK, ROS1, and MET tyrosine kinases, has demonstrated meaningful clinical benefit in these molecular subgroups. Real-world evidence from North Africa remains scarce.

Methods:

This retrospective, single-center, descriptive study included nine consecutive patients with histologically confirmed metastatic NSCLC harboring ALK or ROS1 rearrangements who received crizotinib as first-line monotherapy at the Medical Oncology Department of EH Didouche Mourad, Constantine, Algeria. Tumor response was assessed by RECIST 1.1 criteria and toxicity by CTCAE v5.0.

Results:

Mean age was 56 years (range 30–75); five patients (55.6%) were male. Adenocarcinoma was the predominant histology (88.9%). Performance status was 0 in 77.8% of patients. The most frequent metastatic sites were the pleura (55.6%) and bone (44.4%). All nine patients received crizotinib as first-line therapy. Partial response was achieved in 44.4% and stable disease in 44.4% of patients, yielding a disease control rate of 88.9%. Two patients (22.2%) died during the treatment period; these deaths occurred after documented response assessment. Grade 1 hepatotoxicity was observed in one patient (11.1%), and no treatment discontinuations were recorded.

Conclusion: Crizotinib showed feasible use and acceptable tolerability in metastatic ALK/ROS1-positive NSCLC in this small Algerian cohort. The disease control rate was broadly comparable with published trial data, although interpretation is limited by the small cohort size. Improved access to molecular testing and targeted therapies may help expand the benefits of precision oncology in resource-limited settings.