Real-world Therapy of ALK-positive NSCLC in Sweden: the Sequencing of ALK Tyrosine Kinase Inhibitor Drugs and Their Therapeutic Outcomes Based on Data From National Registers.

• Sponsor: Pfizer (Industry)
• Overall Status: Completed
• CT.gov ID: NCT04647110
• Collaborator: (none)
• Enrollment: 549
• Location: 1
• Actual Duration (Months): 3
• Patients Per Site Per Month: 183.6

Study Details

Study Description

Brief Summary

This study aims to explore for the first time how the different ALK TKIs have been sequenced in real-world clinical practice and with which outcomes for Swedish lung cancer patients

Condition or Disease	Intervention/Treatment	Phase
ALK-positive NSCLC	Drug: crizotinib; Drug: alectinib; Drug: brigatinib; Drug: ceritinib; Drug: lorlatinib

Study Design

• Study Type: Observational
• Actual Enrollment: 549 participants
• Observational Model: Cohort
• Time Perspective: Retrospective
• Official Title: Real-world Study of Non-small Cell Lung Cancer Treatment With ALK-tyrosine Kinase Inhibitors (ALK TKI) in Sweden: Drug Sequencing, Treatment Duration and Overall Survival - A Retrospective Study Using Swedish Register Data
• Actual Study Start Date: Dec 14, 2020
• Actual Primary Completion Date: Mar 15, 2021
• Actual Study Completion Date: Mar 15, 2021

Arms and Interventions

Arm	Intervention/Treatment
Swedish Anaplastic lymphoma kinase (ALK) positive Non-small cell lung cancer (NSCLC) patients	Drug: crizotinib; as provided in real world practice; Drug: alectinib; as provided in real world practice; Drug: brigatinib; as provided in real world practice; Drug: ceritinib; as provided in real world practice; Drug: lorlatinib; as provided in real world practice

Outcome Measures

Primary Outcome Measures

1. Overall Survival (OS): Based on Treatment Cohort Groups [From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. Results were reported for treatment cohort groups based on generation of ALK treatment and were as following: Group A1 = chemotherapy + crizotinib (first generation ALK TKI) + any second (2nd) generation ALK TKI; Group A2 = crizotinib + any 2nd generation ALK TKI; Group B1: chemotherapy + crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group B2 = crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group C1 = chemotherapy + crizotinib + any 2nd generation ALK TKI + lorlatinib (third generation ALK TKI); Group C2: crizotinib + any 2nd generation ALK TKI + lorlatinib and Group D1 = any 2nd generation ALK TKI + any other 2nd generation ALK TKI.

2. Overall Survival: Based on Chemotherapy Status [From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. Results were reported based on chemotherapy status.

3. Overall Survival: Based on Central Nervous System (CNS) Metastases Status [From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. In this outcome measure, participants were grouped on basis of their CNS-metastases status.

4. Overall Survival: Based on ALK Sequencing, 1 Line of ALK TKI Treatment [From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. In this outcome measure, OS was reported for participants who received 1 line of ALK TKI treatment. Reporting arms were based on type of ALK TKI, with or without chemotherapy. ALK TKIs considered were crizotinib, alectinib, ceritinib.

5. Overall Survival: Based on ALK Sequencing, 2 Lines of ALK TKI Treatment [From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. In this outcome measure OS was reported for participants who received 2 lines of ALK TKI treatment. Reporting arms were based on type of first line ALK TKI treatment and second line of ALK TKI treatment, with or without chemotherapy.

6. Overall Survival: Based on ALK Sequencing, 3 Lines of ALK TKI Treatment [From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. In this outcome measure OS was reported for participants who received 3 lines of ALK inhibitor treatment. Reporting arms were based on type of first line ALK TKI treatment, second line of ALK TKI treatment and third line of ALK TKI treatment with or without, chemotherapy.

7. Overall Survival: Based on ALK Sequencing, More Than or Equal to (>=) 4 Lines of ALK TKI Treatment [From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. In this outcome measure, OS was reported for participants who received >=4 lines of ALK inhibitor treatment with or without chemotherapy.

8. Percentage of Participants Alive After 5 Years From Index Date: Based on Treatment Cohort Groups [5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   Results were reported for treatment cohort groups based on generation of ALK treatment and were as following: Group A1 = chemotherapy + crizotinib (first generation ALK TKI) + any second (2nd) generation ALK TKI; Group A2 = crizotinib + any 2nd generation ALK TKI; Group B1: chemotherapy + crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group B2 = crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group C1 = chemotherapy + crizotinib + any 2nd generation ALK TKI + lorlatinib (third generation ALK TKI); Group C2: crizotinib + any 2nd generation ALK TKI + lorlatinib and Group D1 = any 2nd generation ALK TKI + any other 2nd generation ALK TKI.

9. Percentage of Participants Alive After 5 Years From Index Date: Based on Chemotherapy Status [5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   Participants alive after five years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported in this outcome measure. Results were reported based on chemotherapy status.

10. Percentage of Participants Alive After 5 Years From Index Date: Based on CNS Metastases Status [5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

    Participants alive after five years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported in this outcome measure. Results were reported based on CNS metastases status.

11. Percentage of Participants Alive After 5 Years From Index Date: Based on ALK Sequencing, 1 Line of ALK TKI Treatment [5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

    Participants alive after five years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, participants who received 1 line of ALK TKI treatment, were reported. Reporting arms were based on type of first line ALK TKI treatment, with or without chemotherapy. ALK TKIs considered were crizotinib, alectinib, ceritinib.

12. Percentage of Participants Alive After 5 Years From Index Date: Based on ALK Sequencing, 2 Lines of ALK TKI Treatment [5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

    Participants alive after five years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, participants who received 2 lines of ALK TKI treatment, were reported. Reporting arms were based on type of first line ALK TKI treatment and second line of ALK TKI treatment, with or without chemotherapy.

13. Percentage of Participants Alive After 5 Years From Index Date: Based on ALK Sequencing, 3 Lines of ALK TKI Treatment [5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

    Participants alive after five years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, participants who received 3 lines of ALK TKI treatment. Reporting arms were based on type of first line ALK TKI treatment, second line of ALK TKI treatment, and third line of ALK TKI treatment, with or without chemotherapy.

14. Percentage of Participants Alive After 5 Years From Index Date: Based on ALK Sequencing, More Than or Equal to (>=) 4 Lines of ALK TKI Treatment [5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

    Participants alive after five years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, data is reported for participants who received >=4 lines of ALK inhibitor treatment with or without chemotherapy.

15. Percentage of Participants Alive After 6 Years From Index Date: Based on Treatment Cohort Groups [6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

    Results were reported for treatment cohort groups based on generation of ALK treatment and were as following: Group A1 = chemotherapy + crizotinib (first generation ALK TKI) + any second (2nd) generation ALK TKI; Group A2 = crizotinib + any 2nd generation ALK TKI; Group B1: chemotherapy + crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group B2 = crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group C1 = chemotherapy + crizotinib + any 2nd generation ALK TKI + lorlatinib (third generation ALK TKI); Group C2: crizotinib + any 2nd generation ALK TKI + lorlatinib and Group D1 = any 2nd generation ALK TKI + any other 2nd generation ALK TKI.

16. Percentage of Participants Alive After 6 Years From Index Date: Based on Chemotherapy Status [6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

    Participants alive after six years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported in this outcome measure. Results were reported based on chemotherapy status.

17. Percentage of Participants Alive After 6 Years From Index Date: Based on CNS Metastases Status [6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

    Participants alive after six years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported in this outcome measure. Results were reported based on CNS metastases status.

18. Percentage of Participants Alive After 6 Years From Index Date: Based on ALK Sequencing, 1 Line of ALK TKI Treatment [6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

    Participants alive after six years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, participants who received 1 line of ALK TKI treatment, were reported. Reporting arms were based on type of first line ALK TKI treatment, with or without chemotherapy. ALK TKIs considered were crizotinib, alectinib, ceritinib.

19. Percentage of Participants Alive After 6 Years From Index Date: Based on ALK Sequencing, 2 Lines of ALK TKI Treatment [6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

    Participants alive after six years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, participants who received 2 lines of ALK TKI treatment, were reported. Reporting arms were based on type of first line ALK TKI treatment and second line of ALK TKI treatment, with or without chemotherapy.

20. Percentage of Participants Alive After 6 Years From Index Date: Based on ALK Sequencing, 3 Lines of ALK TKI Treatment [6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

    Participants alive after six years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure OS was reported for participants who received 3 lines of ALK inhibitor treatment. Reporting arms were based on type of first line ALK TKI treatment, second line of ALK TKI treatment, and third line of ALK TKI treatment, with or without chemotherapy.

21. Percentage of Participants Alive After 6 Years From Index Date: Based on ALK Sequencing, More Than or Equal to (>=) 4 Lines of ALK TKI Treatment [6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

    Participants alive after six years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, data is reported for participants who received >=4 lines of ALK inhibitor treatment with or without chemotherapy.

Secondary Outcome Measures

1. Duration of Treatment: Based on Treatment Cohort Groups [From index date to treatment completion/discontinuation during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   Duration of treatment was defined as number of days on treatment calculated based on pharmaceutical specialties in Sweden (FASS) recommended dose for filled prescriptions of ALK-inhibitors taking permissible gap and stockpiling into account. Results were reported for treatment cohort groups based on generation of ALK treatment and were as following: Group A1 = chemotherapy + crizotinib (first generation ALK TKI) + any second (2nd) generation ALK TKI; Group A2 = crizotinib + any 2nd generation ALK TKI; Group B1: chemotherapy + crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group B2 = crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group C1 = chemotherapy + crizotinib + any 2nd generation ALK TKI + lorlatinib (third generation ALK TKI); Group C2: crizotinib + any 2nd generation ALK TKI + lorlatinib and Group D1 = any 2nd generation ALK TKI + any other 2nd generation ALK TKI.

2. Duration of Treatment: Based on Chemotherapy Status [From index date to treatment completion/discontinuation during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   Duration of treatment was defined as number of days on treatment calculated based on pharmaceutical specialties in Sweden (FASS) recommended dose for filled prescriptions of ALK-inhibitors taking permissible gap and stockpiling into account. Results were reported based on chemotherapy status.

3. Duration of Treatment: Based on ALK Sequencing, 1 Line of ALK TKI Treatment [From index date to treatment completion/discontinuation during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   Duration of treatment was defined as number of days on treatment calculated based on FASS recommended dose for filled prescriptions of ALK-inhibitors taking permissible gap and stockpiling into account. Reporting arms were based on type of ALK TKI, with or without chemotherapy. ALK TKIs considered were crizotinib, alectinib, ceritinib.

4. Duration of Treatment: Based on ALK Sequencing, 2 Lines of ALK TKI Treatment [From index date to treatment completion/discontinuation during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   Duration of treatment was defined as number of days on treatment calculated based on FASS recommended dose for filled prescriptions of ALK-inhibitors taking permissible gap and stockpiling into account. Reporting arms were based on type of first line ALK TKI treatment, and second line of ALK TKI treatment, with or without chemotherapy.

5. Duration of Treatment: Based on ALK Sequencing, 3 Lines of ALK TKI Treatment [From index date to treatment completion/discontinuation during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   Duration of treatment was defined as number of days on treatment calculated based on FASS recommended dose for filled prescriptions of ALK-inhibitors taking permissible gap and stockpiling into account. Reporting arms were based on type of first line ALK TKI treatment, second line of ALK TKI treatment, and third line of ALK TKI treatment with or without chemotherapy.

6. Duration of Treatment: Based on ALK Sequencing, More Than or Equal to (>=) 4 Lines of ALK TKI Treatment [From index date to treatment completion/discontinuation during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)]

   Duration of treatment was defined as number of days on treatment calculated based on FASS recommended dose for filled prescriptions of ALK-inhibitors taking permissible gap and stockpiling into account. In this outcome measure, duration of treatment was reported for participants who received >=4 lines of ALK inhibitor treatment, with or without chemotherapy.

Eligibility Criteria

Criteria

• Ages Eligible for Study: N/A and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

-Inclusion criteria for ALK-positive NSCLC patients will be based on prescription data i.e. defines eligible patients as adult patients with at least one filled prescription of ALK-inhibitors identified by the national prescription register. Only prescriptions filled at pharmacies can be captured in prescription registers, as they do not include data on hospital drugs. ALK-inhibitor treatments for patients with NSCLC are given primarily outside of the hospital setting minimizing the selection bias under the inclusion criteria.

Exclusion Criteria:

-not applicable

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Pfizer Innovations AB	Sollentuna		Sweden	19190

Sponsors and Collaborators

• Pfizer

Investigators

• Study Director: Pfizer CT.gov Call Center, Pfizer

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Nov 3, 2020

More Information

Additional Information:

• To obtain contact information for a study center near you, click here.

Publications

None provided.

• Responsible Party: Pfizer
• ClinicalTrials.gov Identifier: NCT04647110
• Other Study ID Numbers: B7461035; SEQUIA
• First Posted: Nov 30, 2020
• Last Update Posted: Jul 13, 2022
• Last Verified: Mar 1, 2022

• Individual Participant Data (IPD) Sharing Statement: No
• Plan to Share IPD: No
• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No
• Product Manufactured in and Exported from the U.S.: No
• Additional relevant MeSH terms: Crizotinib; Ceritinib

Study Results

Participant Flow

Recruitment Details

Study population included participants aged greater than or equal to 18 years at index date (date of first ALK TKI prescription), with anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) who had at least one filled prescription of ALK tyrosine kinase inhibitors (TKI) registered in the Swedish Prescribed Drug Register, between 01-Jan-2012 to 31-Dec-2020. Data of eligible participants were assessed in approximately 3 months of this retrospective observational study.

Pre-assignment Detail

According to application sent to ethical counsel for this study, it was pre-planned not to report data for those cohorts/groups which had less than (<) 5 participants at the index date. Hence, due to ethical compliance study team ensured results would only be displayed on an aggregate level for reporting arms having greater than or equal to (>=) 5 participants at index date.

Arm/Group Title	Participants With No First Line Chemotherapy	Participants With First Line Chemotherapy
Arm/Group Description	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, with no first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, along with first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.
Period Title: Overall Study
STARTED	345	204
COMPLETED	345	204
NOT COMPLETED	0	0

Baseline Characteristics

Arm/Group Title	Participants With No First Line Chemotherapy	Participants With First Line Chemotherapy	Total
Arm/Group Description	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, with no first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, along with first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.	Total of all reporting groups
Overall Participants	345	204	549
Age (Years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [Years]	63.08 (13.96)	63.24 (13.28)	63.13 (13.70)
Sex: Female, Male (Count of Participants)
Female	189 54.8%	112 54.9%	301 54.8%
Male	156 45.2%	92 45.1%	248 45.2%
Race and Ethnicity Not Collected (Count of Participants)
Count of Participants [Participants]	0 0%

Outcome Measures

1. Secondary Outcome

Title	Duration of Treatment: Based on Treatment Cohort Groups
Description	Duration of treatment was defined as number of days on treatment calculated based on pharmaceutical specialties in Sweden (FASS) recommended dose for filled prescriptions of ALK-inhibitors taking permissible gap and stockpiling into account. Results were reported for treatment cohort groups based on generation of ALK treatment and were as following: Group A1 = chemotherapy + crizotinib (first generation ALK TKI) + any second (2nd) generation ALK TKI; Group A2 = crizotinib + any 2nd generation ALK TKI; Group B1: chemotherapy + crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group B2 = crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group C1 = chemotherapy + crizotinib + any 2nd generation ALK TKI + lorlatinib (third generation ALK TKI); Group C2: crizotinib + any 2nd generation ALK TKI + lorlatinib and Group D1 = any 2nd generation ALK TKI + any other 2nd generation ALK TKI.
Time Frame	From index date to treatment completion/discontinuation during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed" signifies participants who were evaluable for this outcome measure based on generation of ALK treatment.

Arm/Group Title	Group A1	Group A2	Group B1	Group B2	Group C1	Group C2	Group D1
Arm/Group Description	Participants included in this arm received chemotherapy, crizotinib, and any second generation ALK TKI, in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received crizotinib and any second generation ALK TKI in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received chemotherapy, crizotinib and any two second generation ALK TKIs in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received, crizotinib and any two second generation ALK TKIs in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received chemotherapy, crizotinib, any second generation ALK TKI and lorlatinib in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received crizotinib, any second generation ALK TKI and lorlatinib in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received any two second generation ALK TKIs in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.
Measure Participants	29	71	10	14	5	9	9
Mean (Standard Deviation) [Years]	1.66 (1.28)	1.86 (1.31)	3.37 (1.24)	2.45 (1.53)	2.56 (1.42)	2.72 (1.03)	1.36 (0.75)

2. Secondary Outcome

Title	Duration of Treatment: Based on Chemotherapy Status
Description	Duration of treatment was defined as number of days on treatment calculated based on pharmaceutical specialties in Sweden (FASS) recommended dose for filled prescriptions of ALK-inhibitors taking permissible gap and stockpiling into account. Results were reported based on chemotherapy status.
Time Frame	From index date to treatment completion/discontinuation during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed.

Arm/Group Title	Participants With No First Line Chemotherapy	Participants With First Line Chemotherapy
Arm/Group Description	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, with no first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, along with first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.
Measure Participants	345	204
Mean (Standard Deviation) [Years]	1.23 (1.28)	1.07 (1.28)

3. Secondary Outcome

Title	Duration of Treatment: Based on ALK Sequencing, 1 Line of ALK TKI Treatment
Description	Duration of treatment was defined as number of days on treatment calculated based on FASS recommended dose for filled prescriptions of ALK-inhibitors taking permissible gap and stockpiling into account. Reporting arms were based on type of ALK TKI, with or without chemotherapy. ALK TKIs considered were crizotinib, alectinib, ceritinib.
Time Frame	From index date to treatment completion/discontinuation during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed (N)" signifies participants evaluable for this measure and received only 1 line of ALK TKIs with/ without chemotherapy. Due to ethical compliance, it was pre-planned not to report data for those reporting groups which had <5 participants at the index date.

Arm/Group Title	Crizotinib	Alectinib	Ceritinib	Crizotinib + Chemotherapy	Alectinib + Chemotherapy	Ceritinib + Chemotherapy
Arm/Group Description	Participants included in this arm received only crizotinib in real world practices	Participants included in this arm received only alectinib in real world practices.	Participants included in this arm received only ceritinib in real world practices.	Participants included in this arm received crizotinib in real world practices along with chemotherapy.	Participants included in this arm received alectinib in real world practices along with chemotherapy.	Participants included in this arm received ceritinib in real world practices along with chemotherapy.
Measure Participants	116	105	4	95	41	5
First Line ALK TKI Treatment Duration	0.72 (1.19)	0.92 (0.82)	NA (NA)	0.50 (0.80)	0.80 (0.88)	1.01 (1.23)
Total Sequence Treatment Duration	0.72 (1.19)	0.92 (0.82)	NA (NA)	0.50 (0.80)	0.80 (0.88)	1.01 (1.23)

4. Secondary Outcome

Title	Duration of Treatment: Based on ALK Sequencing, 2 Lines of ALK TKI Treatment
Description	Duration of treatment was defined as number of days on treatment calculated based on FASS recommended dose for filled prescriptions of ALK-inhibitors taking permissible gap and stockpiling into account. Reporting arms were based on type of first line ALK TKI treatment, and second line of ALK TKI treatment, with or without chemotherapy.
Time Frame	From index date to treatment completion/discontinuation during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. "Overall Number of Participants Analyzed (N)": participants evaluable for this measure and received only 2 lines of ALK TKIs with/ without chemotherapy. Groups with "N" =0: no participants with respective ALK TKI sequencing. Due to ethical compliance, it was pre-planned not to report data for those reporting groups which had <5 participants at the index date.

Arm/Group Title	Crizotinib + Alectinib	Crizotinib + Brigatinib	Crizotinib + Ceritinib	Alectinib + Brigatinib	Alectinib + Ceritinib	Alectinib + Lorlatinib	Ceritinib + Alectinib	Ceritinib + Brigatinib	Ceritinib + Lorlatinib	Crizotinib + Alectinib + Chemotherapy	Crizotinib + Brigatinib + Chemotherapy	Crizotinib + Ceritinib + Chemotherapy	Alectinib + Brigatinib + Chemotherapy	Alectinib + Ceritinib + Chemotherapy	Alectinib + Lorlatinib + Chemotherapy	Ceritinib + Alectinib + Chemotherapy	Ceritinib + Brigatinib + Chemotherapy	Ceritinib + Lorlatinib + Chemotherapy
Arm/Group Description	Participants included in this arm received crizotinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.
Measure Participants	33	0	38	8	0	6	1	0	1	9	2	18	2	1	7	2	0	0
First Line ALK TKI Treatment Duration	1.01 (0.80)	0.62 (0.45)	0.61 (0.51)	0.95 (0.62)	NA (NA)	NA (NA)	1.42 (1.31)	NA (NA)	0.81 (0.70)	NA (NA)	NA (NA)	0.50 (0.60)	NA (NA)
Second Line ALK TKI Treatment Duration	1.62 (1.07)	0.58 (0.72)	0.55 (0.34)	0.27 (0.23)	NA (NA)	NA (NA)	0.75 (0.89)	NA (NA)	0.37 (0.67)	NA (NA)	NA (NA)	0.40 (0.37)	NA (NA)
Total Sequence Treatment Duration	2.62 (1.33)	1.21 (0.86)	1.16 (0.51)	1.22 (0.57)	NA (NA)	NA (NA)	2.17 (1.32)	NA (NA)	1.18 (0.99)	NA (NA)	NA (NA)	0.89 (0.64)	NA (NA)

5. Secondary Outcome

Title	Duration of Treatment: Based on ALK Sequencing, 3 Lines of ALK TKI Treatment
Description	Duration of treatment was defined as number of days on treatment calculated based on FASS recommended dose for filled prescriptions of ALK-inhibitors taking permissible gap and stockpiling into account. Reporting arms were based on type of first line ALK TKI treatment, second line of ALK TKI treatment, and third line of ALK TKI treatment with or without chemotherapy.
Time Frame	From index date to treatment completion/discontinuation during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. "Overall Number of Participants Analyzed (N)": participants evaluable for this measure and received only 3 lines of ALK TKIs with/ without chemotherapy. Groups with "N" =0: no participants with respective ALK TKI sequencing. Due to ethical compliance, it was pre-planned not to report data for those reporting groups which had <5 participants at the index date.

Arm/Group Title	Crizotinib + Alectinib + Ceritinib	Crizotinib + Alectinib + Lorlatinib	Crizotinib + Alectinib + Brigatinib	Crizotinib + Ceritinib + Alectinib	Crizotinib + Ceritinib + Lorlatinib	Crizotinib + Ceritinib + Brigatinib	Crizotinib + Brigatinib + Alectinib	Crizotinib + Brigatinib + Lorlatinib	Alectinib + Brigatinib + Lorlatinib	Alectinib + Lorlatinib + Brigatinib	Alectinib + Lorlatinib + Ceritinib	Ceritinib + Alectinib + Lorlatinib	Ceritinib + Alectinib + Brigatinib	Crizotinib + Alectinib + Ceritinib + Chemotherapy	Crizotinib + Alectinib + Lorlatinib + Chemotherapy	Crizotinib + Alectinib + Brigatinib + Chemotherapy	Crizotinib + Ceritinib + Alectinib + Chemotherapy	Crizotinib + Ceritinib + Lorlatinib + Chemotherapy	Crizotinib + Ceritinib + Brigatinib + Chemotherapy	Crizotinib + Brigatinib + Alectinib + Chemotherapy	Crizotinib + Brigatinib + Lorlatinib + Chemotherapy	Alectinib + Brigatinib + Lorlatinib + Chemotherapy	Alectinib + Lorlatinib + Brigatinib + Chemotherapy	Alectinib + Lorlatinib + Ceritinib + Chemotherapy	Ceritinib + Alectinib + Lorlatinib + Chemotherapy	Ceritinib + Alectinib + Brigatinib + Chemotherapy
Arm/Group Description	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and ceritinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment and alectinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment and alectinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment and ceritinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, ceritinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment, alectinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment, alectinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment, ceritinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.
Measure Participants	0	7	3	11	1	0	0	1	1	1	0	0	0	1	1	3	6	2	0	0	2	0	0	0	0	0
First Line ALK TKI Treatment Duration	1.12 (1.13)	NA (NA)	0.70 (0.38)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	1.12 (0.63)	NA (NA)	NA (NA)
Second Line ALK TKI Treatment Duration	1.29 (0.69)	NA (NA)	0.85 (0.81)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	1.53 (1.31)	NA (NA)	NA (NA)
Third Line ALK TKI Treatment Duration	0.47 (0.37)	NA (NA)	0.85 (0.90)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	0.68 (1.07)	NA (NA)	NA (NA)
Total Sequence Treatment Duration	2.88 (1.13)	NA (NA)	2.39 (1.65)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	NA (NA)	3.34 (1.01)	NA (NA)	NA (NA)

6. Secondary Outcome

Title	Duration of Treatment: Based on ALK Sequencing, More Than or Equal to (>=) 4 Lines of ALK TKI Treatment
Description	Duration of treatment was defined as number of days on treatment calculated based on FASS recommended dose for filled prescriptions of ALK-inhibitors taking permissible gap and stockpiling into account. In this outcome measure, duration of treatment was reported for participants who received >=4 lines of ALK inhibitor treatment, with or without chemotherapy.
Time Frame	From index date to treatment completion/discontinuation during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed" signifies participants who were evaluable for this outcome measure and received >= 4 lines of ALK TKI treatment with or without chemotherapy.

Arm/Group Title	>=4 Lines of ALK TKI	>=4 Lines of ALK TKI With Chemotherapy
Arm/Group Description	Participants included in this arm received at least 4 different ALK TKIs, in real world practices.	Participants included in this arm received at least 4 different ALK TKIs, in real world practices along with chemotherapy.
Measure Participants	8	7
First Line ALK TKI Treatment Duration	1.09 (0.61)	1.56 (0.82)
Second Line ALK TKI Treatment Duration	1.01 (0.73)	0.73 (0.49)
Third Line ALK TKI Treatment Duration	0.80 (0.63)	0.63 (0.56)
Fourth Line ALK TKI Treatment Duration	0.52 (0.48)	0.47 (0.50)
Total Sequence Treatment Duration	3.42 (0.98)	3.40 (1.76)

7. Primary Outcome

Title	Overall Survival (OS): Based on Treatment Cohort Groups
Description	OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. Results were reported for treatment cohort groups based on generation of ALK treatment and were as following: Group A1 = chemotherapy + crizotinib (first generation ALK TKI) + any second (2nd) generation ALK TKI; Group A2 = crizotinib + any 2nd generation ALK TKI; Group B1: chemotherapy + crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group B2 = crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group C1 = chemotherapy + crizotinib + any 2nd generation ALK TKI + lorlatinib (third generation ALK TKI); Group C2: crizotinib + any 2nd generation ALK TKI + lorlatinib and Group D1 = any 2nd generation ALK TKI + any other 2nd generation ALK TKI.
Time Frame	From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed" signifies participants who were evaluable for this outcome measure based on generation of ALK treatment.

Arm/Group Title	Group A1	Group A2	Group B1	Group B2	Group C1	Group C2	Group D1
Arm/Group Description	Participants included in this arm received chemotherapy, crizotinib, and any second generation ALK TKI, in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received crizotinib and any second generation ALK TKI in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received chemotherapy, crizotinib and any two second generation ALK TKIs in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received, crizotinib and any two second generation ALK TKIs in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received chemotherapy, crizotinib, any second generation ALK TKI and lorlatinib in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received crizotinib, any second generation ALK TKI and lorlatinib in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received any two second generation ALK TKIs in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.
Measure Participants	29	71	10	14	5	9	9
Median (95% Confidence Interval) [Years]	1.94	2.30	4.56	2.94	NA	5.41	NA

8. Primary Outcome

Title	Overall Survival: Based on Chemotherapy Status
Description	OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. Results were reported based on chemotherapy status.
Time Frame	From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed.

Arm/Group Title	Participants With No First Line Chemotherapy	Participants With First Line Chemotherapy
Arm/Group Description	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, with no first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, along with first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.
Measure Participants	345	204
Median (95% Confidence Interval) [Years]	2.02	1.44

9. Primary Outcome

Title	Overall Survival: Based on Central Nervous System (CNS) Metastases Status
Description	OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. In this outcome measure, participants were grouped on basis of their CNS-metastases status.
Time Frame	From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed.

Arm/Group Title	Participants With No CNS Metastases	Participants With CNS Metastases
Arm/Group Description	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, with or without first line chemotherapy treatment and had no CNS metastases during 2 years period prior to index date. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, with or without first line chemotherapy treatment and had CNS metastases during 2 years period prior to index date. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.
Measure Participants	520	29
Median (95% Confidence Interval) [Years]	1.94	0.61

10. Primary Outcome

Title	Overall Survival: Based on ALK Sequencing, 1 Line of ALK TKI Treatment
Description	OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. In this outcome measure, OS was reported for participants who received 1 line of ALK TKI treatment. Reporting arms were based on type of ALK TKI, with or without chemotherapy. ALK TKIs considered were crizotinib, alectinib, ceritinib.
Time Frame	From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed (N)" signifies participants evaluable for this measure and received only 1 line of ALK TKIs with/ without chemotherapy. Due to ethical compliance, it was pre-planned not to report data for those reporting groups which had <5 participants at the index date.

Arm/Group Title	Crizotinib	Alectinib	Ceritinib	Crizotinib + Chemotherapy	Alectinib + Chemotherapy	Ceritinib + Chemotherapy
Arm/Group Description	Participants included in this arm received only crizotinib in real world practices.	Participants included in this arm received only alectinib in real world practices.	Participants included in this arm received only ceritinib in real world practices.	Participants included in this arm received crizotinib in real world practices along with chemotherapy.	Participants included in this arm received alectinib in real world practices along with chemotherapy.	Participants included in this arm received ceritinib in real world practices along with chemotherapy.
Measure Participants	116	105	4	95	41	5
Median (95% Confidence Interval) [Years]	0.88	NA	NA	0.63	NA	0.59

11. Primary Outcome

Title	Overall Survival: Based on ALK Sequencing, 2 Lines of ALK TKI Treatment
Description	OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. In this outcome measure OS was reported for participants who received 2 lines of ALK TKI treatment. Reporting arms were based on type of first line ALK TKI treatment and second line of ALK TKI treatment, with or without chemotherapy.
Time Frame	From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. "Overall Number of Participants Analyzed (N)": participants evaluable for this measure and received only 2 lines of ALK TKIs with/ without chemotherapy. Groups with "N" =0: no participants with respective ALK TKI sequencing. Due to ethical compliance, it was pre-planned not to report data for those reporting groups which had <5 participants at the index date.

Arm/Group Title	Crizotinib + Alectinib	Crizotinib + Brigatinib	Crizotinib + Ceritinib	Alectinib + Brigatinib	Alectinib + Ceritinib	Alectinib + Lorlatinib	Ceritinib + Alectinib	Ceritinib + Brigatinib	Ceritinib + Lorlatinib	Crizotinib + Alectinib + Chemotherapy	Crizotinib + Brigatinib + Chemotherapy	Crizotinib + Ceritinib + Chemotherapy	Alectinib + Brigatinib + Chemotherapy	Alectinib + Ceritinib + Chemotherapy	Alectinib + Lorlatinib + Chemotherapy	Ceritinib + Alectinib + Chemotherapy	Ceritinib + Brigatinib + Chemotherapy	Ceritinib + Lorlatinib + Chemotherapy
Arm/Group Description	Participants included in this arm received crizotinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.
Measure Participants	33	0	38	8	0	6	1	0	1	9	2	18	2	1	7	2	0	0
Median (95% Confidence Interval) [Years]	NA	1.27	NA	NA	NA	NA	2.69	NA	1.38	NA	NA	NA	NA

12. Primary Outcome

Title	Overall Survival: Based on ALK Sequencing, 3 Lines of ALK TKI Treatment
Description	OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. In this outcome measure OS was reported for participants who received 3 lines of ALK inhibitor treatment. Reporting arms were based on type of first line ALK TKI treatment, second line of ALK TKI treatment and third line of ALK TKI treatment with or without, chemotherapy.
Time Frame	From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. "Overall Number of Participants Analyzed (N)": participants evaluable for this measure and received only 3 lines of ALK TKIs with/ without chemotherapy. Groups with "N" =0: no participants with respective ALK TKI sequencing. Due to ethical compliance, it was pre-planned not to report data for those reporting groups which had <5 participants at the index date.

Arm/Group Title	Crizotinib + Alectinib + Ceritinib	Crizotinib + Alectinib + Lorlatinib	Crizotinib + Alectinib + Brigatinib	Crizotinib + Ceritinib + Alectinib	Crizotinib + Ceritinib + Lorlatinib	Crizotinib + Ceritinib + Brigatinib	Crizotinib + Brigatinib + Alectinib	Crizotinib + Brigatinib + Lorlatinib	Alectinib + Brigatinib + Lorlatinib	Alectinib + Lorlatinib + Brigatinib	Alectinib + Lorlatinib + Ceritinib	Ceritinib + Alectinib + Lorlatinib	Ceritinib + Alectinib + Brigatinib	Crizotinib + Alectinib + Ceritinib + Chemotherapy	Crizotinib + Alectinib + Lorlatinib + Chemotherapy	Crizotinib + Alectinib + Brigatinib + Chemotherapy	Crizotinib + Ceritinib + Alectinib + Chemotherapy	Crizotinib + Ceritinib + Lorlatinib + Chemotherapy	Crizotinib + Ceritinib + Brigatinib + Chemotherapy	Crizotinib + Brigatinib + Alectinib + Chemotherapy	Crizotinib + Brigatinib + Lorlatinib + Chemotherapy	Alectinib + Brigatinib + Lorlatinib + Chemotherapy	Alectinib + Lorlatinib + Brigatinib +Chemotherapy	Alectinib + Lorlatinib + Ceritinib + Chemotherapy	Ceritinib + Alectinib + Lorlatinib + Chemotherapy	Ceritinib + Alectinib + Brigatinib + Chemotherapy
Arm/Group Description	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and ceritinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment and alectinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment and alectinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment and ceritinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, ceritinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment, alectinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment, alectinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment, ceritinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.
Measure Participants	0	7	3	11	1	0	0	1	1	1	0	0	0	1	1	3	6	2	0	0	2	0	0	0	0	0
Median (95% Confidence Interval) [Years]	5.41	NA	2.78	NA	NA	NA	NA	NA	NA	NA	4.06	NA	NA

13. Primary Outcome

Title	Overall Survival: Based on ALK Sequencing, More Than or Equal to (>=) 4 Lines of ALK TKI Treatment
Description	OS was defined as the time from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data). Kaplan-Meier method was used for analysis. In this outcome measure, OS was reported for participants who received >=4 lines of ALK inhibitor treatment with or without chemotherapy.
Time Frame	From index date to the date of death due to any cause or censoring date, during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed" signifies participants who were evaluable for this outcome measure and received >= 4 lines of ALK TKI treatment with or without chemotherapy.

Arm/Group Title	>=4 Lines of ALK TKI	>=4 Lines of ALK TKI With Chemotherapy
Arm/Group Description	Participants included in this arm received at least 4 different ALK TKIs, in real world practices.	Participants included in this arm received at least 4 different ALK TKIs, in real world practices along with chemotherapy.
Measure Participants	8	7
Median (95% Confidence Interval) [Years]	5.49	5.27

14. Primary Outcome

Title	Percentage of Participants Alive After 5 Years From Index Date: Based on Treatment Cohort Groups
Description	Results were reported for treatment cohort groups based on generation of ALK treatment and were as following: Group A1 = chemotherapy + crizotinib (first generation ALK TKI) + any second (2nd) generation ALK TKI; Group A2 = crizotinib + any 2nd generation ALK TKI; Group B1: chemotherapy + crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group B2 = crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group C1 = chemotherapy + crizotinib + any 2nd generation ALK TKI + lorlatinib (third generation ALK TKI); Group C2: crizotinib + any 2nd generation ALK TKI + lorlatinib and Group D1 = any 2nd generation ALK TKI + any other 2nd generation ALK TKI.
Time Frame	5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed (N)" signifies participants who evaluable for this measure with a follow up of 5 years post index date. Reporting groups with "N" =0 signifies that no participant had a follow up of 5 years post index date.

Arm/Group Title	Group A1	Group A2	Group B1	Group B2	Group C1	Group C2	Group D1
Arm/Group Description	Participants included in this arm received chemotherapy, crizotinib, and any second generation ALK TKI, in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received crizotinib and any second generation ALK TKI in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received chemotherapy, crizotinib and any two second generation ALK TKIs in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received, crizotinib and any two second generation ALK TKIs in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received chemotherapy, crizotinib, any second generation ALK TKI and lorlatinib in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received crizotinib, any second generation ALK TKI and lorlatinib in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received any two second generation ALK TKIs in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.
Measure Participants	16	21	5	2	3	1	0
Number [Percentage of participants]	6.25 1.8%	9.52 4.7%	40.00 7.3%	50.00 NaN	66.67 NaN	100 NaN

15. Primary Outcome

Title	Percentage of Participants Alive After 5 Years From Index Date: Based on Chemotherapy Status
Description	Participants alive after five years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported in this outcome measure. Results were reported based on chemotherapy status.
Time Frame	5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed" signifies participants who were evaluable for this outcome measure with a follow up of 5 years post index date.

Arm/Group Title	Participants With No First Line Chemotherapy	Participants With First Line Chemotherapy
Arm/Group Description	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, with no first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, along with first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.
Measure Participants	61	61
Number [Percentage of participants]	16.39 4.8%	16.39 8%

16. Primary Outcome

Title	Percentage of Participants Alive After 5 Years From Index Date: Based on CNS Metastases Status
Description	Participants alive after five years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported in this outcome measure. Results were reported based on CNS metastases status.
Time Frame	5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed" signifies participants who were evaluable for this outcome measure with a follow up of 5 years post index date.

Arm/Group Title	Participants With No CNS Metastases	Participants With CNS Metastases
Arm/Group Description	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, with or without first line chemotherapy treatment and had no CNS metastases during 2 years period prior to index date. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, with or without first line chemotherapy treatment and had CNS metastases during 2 years period prior to index date. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.
Measure Participants	116	6
Number [Percentage of participants]	17.24 5%	0.00 0%

17. Primary Outcome

Title	Percentage of Participants Alive After 5 Years From Index Date: Based on ALK Sequencing, 1 Line of ALK TKI Treatment
Description	Participants alive after five years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, participants who received 1 line of ALK TKI treatment, were reported. Reporting arms were based on type of first line ALK TKI treatment, with or without chemotherapy. ALK TKIs considered were crizotinib, alectinib, ceritinib.
Time Frame	5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed" signifies participants who were evaluable for this outcome measure with a follow up of 5 years post index date. Reporting arm with "Overall Number of Participants Analyzed" = 0, signifies that no participant had a follow up of 5 years post index date.

Arm/Group Title	Crizotinib	Alectinib	Ceritinib	Crizotinib + Chemotherapy	Alectinib + Chemotherapy	Ceritinib + Chemotherapy
Arm/Group Description	Participants included in this arm received only crizotinib in real world practices.	Participants included in this arm received only alectinib in real world practices.	Participants included in this arm received only ceritinib in real world practices.	Participants included in this arm received crizotinib in real world practices along with chemotherapy.	Participants included in this arm received alectinib in real world practices along with chemotherapy.	Participants included in this arm received ceritinib in real world practices along with chemotherapy.
Measure Participants	35	0	0	32	0	0
Number [Percentage of participants]	11.43 3.3%	0.00 0%

18. Primary Outcome

Title	Percentage of Participants Alive After 5 Years From Index Date: Based on ALK Sequencing, 2 Lines of ALK TKI Treatment
Description	Participants alive after five years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, participants who received 2 lines of ALK TKI treatment, were reported. Reporting arms were based on type of first line ALK TKI treatment and second line of ALK TKI treatment, with or without chemotherapy.
Time Frame	5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed (N)" signifies participants who evaluable for this measure with a follow up of 5 years post index date. Reporting groups with "N" =0 signifies that no participant had a follow up of 5 years post index date.

Arm/Group Title	Crizotinib + Alectinib	Crizotinib + Brigatinib	Crizotinib + Ceritinib	Alectinib + Brigatinib	Alectinib + Ceritinib	Alectinib + Lorlatinib	Ceritinib + Alectinib	Ceritinib + Brigatinib	Ceritinib + Lorlatinib	Crizotinib + Alectinib + Chemotherapy	Crizotinib + Brigatinib + Chemotherapy	Crizotinib + Ceritinib + Chemotherapy	Alectinib + Brigatinib + Chemotherapy	Alectinib + Ceritinib + Chemotherapy	Alectinib + Lorlatinib + Chemotherapy	Ceritinib + Alectinib + Chemotherapy	Ceritinib + Brigatinib + Chemotherapy	Ceritinib + Lorlatinib + Chemotherapy
Arm/Group Description	Participants included in this arm received crizotinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.
Measure Participants	3	0	18	0	0	0	0	0	0	2	0	14	0	0	0	0	0	0
Number [Percentage of participants]	66.67 19.3%	0.00 0%	0.00 0%	7.14 NaN

19. Primary Outcome

Title	Percentage of Participants Alive After 5 Years From Index Date: Based on ALK Sequencing, 3 Lines of ALK TKI Treatment
Description	Participants alive after five years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, participants who received 3 lines of ALK TKI treatment. Reporting arms were based on type of first line ALK TKI treatment, second line of ALK TKI treatment, and third line of ALK TKI treatment, with or without chemotherapy.
Time Frame	5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed (N)" signifies participants who evaluable for this measure with a follow up of 5 years post index date. Reporting groups with "N" =0 signifies that no participant had a follow up of 5 years post index date.

Arm/Group Title	Crizotinib + Alectinib + Ceritinib	Crizotinib + Alectinib + Lorlatinib	Crizotinib + Alectinib + Brigatinib	Crizotinib + Ceritinib + Alectinib	Crizotinib + Ceritinib + Lorlatinib	Crizotinib + Ceritinib + Brigatinib	Crizotinib + Brigatinib + Alectinib	Crizotinib + Brigatinib + Lorlatinib	Alectinib + Brigatinib + Lorlatinib	Alectinib + Lorlatinib + Brigatinib	Alectinib + Lorlatinib + Ceritinib	Ceritinib + Alectinib + Lorlatinib	Ceritinib + Alectinib + Brigatinib	Crizotinib + Alectinib + Ceritinib + Chemotherapy	Crizotinib + Alectinib + Lorlatinib + Chemotherapy	Crizotinib + Alectinib + Brigatinib + Chemotherapy	Crizotinib + Ceritinib + Alectinib + Chemotherapy	Crizotinib + Ceritinib + Lorlatinib + Chemotherapy	Crizotinib + Ceritinib + Brigatinib + Chemotherapy	Crizotinib + Brigatinib + Alectinib + Chemotherapy	Crizotinib + Brigatinib + Lorlatinib + Chemotherapy	Alectinib + Brigatinib + Lorlatinib +Chemotherapy	Alectinib + Lorlatinib + Brigatinib +Chemotherapy	Alectinib + Lorlatinib + Ceritinib + Chemotherapy	Ceritinib + Alectinib + Lorlatinib + Chemotherapy	Ceritinib + Alectinib + Brigatinib + Chemotherapy
Arm/Group Description	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and ceritinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment and alectinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment and alectinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment and ceritinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, ceritinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment, alectinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment, alectinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment, ceritinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.
Measure Participants	0	1	0	2	0	0	0	0	0	0	0	0	0	0	0	0	4	0	0	0	0	0	0	0	0	0
Number [Percentage of participants]	100.00 29%	50.00 24.5%	25.00 4.6%

20. Primary Outcome

Title	Percentage of Participants Alive After 5 Years From Index Date: Based on ALK Sequencing, More Than or Equal to (>=) 4 Lines of ALK TKI Treatment
Description	Participants alive after five years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, data is reported for participants who received >=4 lines of ALK inhibitor treatment with or without chemotherapy.
Time Frame	5 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed" signifies participants who were evaluable for this outcome measure with a follow up of 5 years post index date.

Arm/Group Title	>=4 Lines of ALK TKI	>=4 Lines of ALK TKI With Chemotherapy
Arm/Group Description	Participants included in this arm received at least 4 different ALK TKIs, in real world practices.	Participants included in this arm received at least 4 different ALK TKIs, in real world practices along with chemotherapy.
Measure Participants	2	5
Number [Percentage of participants]	100.00 29%	100.00 49%

21. Primary Outcome

Title	Percentage of Participants Alive After 6 Years From Index Date: Based on Treatment Cohort Groups
Description	Results were reported for treatment cohort groups based on generation of ALK treatment and were as following: Group A1 = chemotherapy + crizotinib (first generation ALK TKI) + any second (2nd) generation ALK TKI; Group A2 = crizotinib + any 2nd generation ALK TKI; Group B1: chemotherapy + crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group B2 = crizotinib + any 2nd generation ALK TKI + any other 2nd generation ALK TKI; Group C1 = chemotherapy + crizotinib + any 2nd generation ALK TKI + lorlatinib (third generation ALK TKI); Group C2: crizotinib + any 2nd generation ALK TKI + lorlatinib and Group D1 = any 2nd generation ALK TKI + any other 2nd generation ALK TKI.
Time Frame	6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed (N)" signifies participants who evaluable for this measure with a follow up of 6 years post index date. Reporting groups with "N" =0 signifies that no participant had a follow up of 6 years post index date.

Arm/Group Title	Group A1	Group A2	Group B1	Group B2	Group C1	Group C2	Group D1
Arm/Group Description	Participants included in this arm received chemotherapy, crizotinib, and any second generation ALK TKI, in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received crizotinib and any second generation ALK TKI in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received chemotherapy, crizotinib and any two second generation ALK TKIs in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received, crizotinib and any two second generation ALK TKIs in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received chemotherapy, crizotinib, any second generation ALK TKI and lorlatinib in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received crizotinib, any second generation ALK TKI and lorlatinib in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.	Participants included in this arm received any two second generation ALK TKIs in real world practices. Second generation ALK TKIs considered were alectinib, brigatinib, or ceritinib.
Measure Participants	5	3	1	0	1	0	0
Number [Percentage of participants]	0.00 0%	0.00 0%	0.00 0%	0.00 NaN

22. Primary Outcome

Title	Percentage of Participants Alive After 6 Years From Index Date: Based on Chemotherapy Status
Description	Participants alive after six years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported in this outcome measure. Results were reported based on chemotherapy status.
Time Frame	6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed" signifies participants who were evaluable for this outcome measure with a follow up of 6 years post index date.

Arm/Group Title	Participants With No First Line Chemotherapy	Participants With First Line Chemotherapy
Arm/Group Description	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, with no first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, along with first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.
Measure Participants	20	26
Number [Percentage of participants]	10.00 2.9%	3.85 1.9%

23. Primary Outcome

Title	Percentage of Participants Alive After 6 Years From Index Date: Based on CNS Metastases Status
Description	Participants alive after six years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported in this outcome measure. Results were reported based on CNS metastases status.
Time Frame	6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed" signifies participants who were evaluable for this outcome measure with a follow up of 6 years post index date.

Arm/Group Title	Participants With No CNS Metastases	Participants With CNS Metastases
Arm/Group Description	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, with or without first line chemotherapy treatment and had no CNS metastases during 2 years period prior to index date. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, with or without first line chemotherapy treatment and had CNS metastases during 2 years period prior to index date. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.
Measure Participants	44	2
Number [Percentage of participants]	6.82 2%	0.00 0%

24. Primary Outcome

Title	Percentage of Participants Alive After 6 Years From Index Date: Based on ALK Sequencing, 1 Line of ALK TKI Treatment
Description	Participants alive after six years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, participants who received 1 line of ALK TKI treatment, were reported. Reporting arms were based on type of first line ALK TKI treatment, with or without chemotherapy. ALK TKIs considered were crizotinib, alectinib, ceritinib.
Time Frame	6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed" signifies participants who were evaluable for this outcome measure with a follow up of 6 years post index date. Reporting arm with "Overall Number of Participants Analyzed" = 0, signifies that no participant had a follow up of 6 years post index date.

Arm/Group Title	Crizotinib	Alectinib	Ceritinib	Crizotinib + Chemotherapy	Alectinib + Chemotherapy	Ceritinib + Chemotherapy
Arm/Group Description	Participants included in this arm received only crizotinib in real world practices.	Participants included in this arm received only alectinib in real world practices.	Participants included in this arm received only ceritinib in real world practices.	Participants included in this arm received crizotinib in real world practices along with chemotherapy.	Participants included in this arm received alectinib in real world practices along with chemotherapy.	Participants included in this arm received ceritinib in real world practices along with chemotherapy.
Measure Participants	16	0	0	16	0	0
Number [Percentage of participants]	12.50 3.6%	0.00 0%

25. Primary Outcome

Title	Percentage of Participants Alive After 6 Years From Index Date: Based on ALK Sequencing, 2 Lines of ALK TKI Treatment
Description	Participants alive after six years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, participants who received 2 lines of ALK TKI treatment, were reported. Reporting arms were based on type of first line ALK TKI treatment and second line of ALK TKI treatment, with or without chemotherapy.
Time Frame	6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed (N)" signifies participants who evaluable for this measure with a follow up of 6 years post index date. Reporting groups with "N" =0 signifies that no participant had a follow up of 6 years post index date.

Arm/Group Title	Crizotinib + Alectinib	Crizotinib + Brigatinib	Crizotinib + Ceritinib	Alectinib + Brigatinib	Alectinib + Ceritinib	Alectinib + Lorlatinib	Ceritinib + Alectinib	Ceritinib + Brigatinib	Ceritinib + Lorlatinib	Crizotinib + Alectinib + Chemotherapy	Crizotinib + Brigatinib + Chemotherapy	Crizotinib + Ceritinib + Chemotherapy	Alectinib + Brigatinib + Chemotherapy	Alectinib + Ceritinib + Chemotherapy	Alectinib + Lorlatinib + Chemotherapy	Ceritinib + Alectinib + Chemotherapy	Ceritinib + Brigatinib + Chemotherapy	Ceritinib + Lorlatinib + Chemotherapy
Arm/Group Description	Participants included in this arm received crizotinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK KI treatment and ceritinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK KI treatment and alectinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK KI treatment and brigatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK KI treatment and lorlatinib as second line ALK TKI treatment, in real world practices along with chemotherapy.
Measure Participants	1	0	2	0	0	0	0	0	0	0	0	5	0	0	0	0	0	0
Number [Percentage of participants]	0.00 0%	0.00 0%	0.00 0%

26. Primary Outcome

Title	Percentage of Participants Alive After 6 Years From Index Date: Based on ALK Sequencing, 3 Lines of ALK TKI Treatment
Description	Participants alive after six years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure OS was reported for participants who received 3 lines of ALK inhibitor treatment. Reporting arms were based on type of first line ALK TKI treatment, second line of ALK TKI treatment, and third line of ALK TKI treatment, with or without chemotherapy.
Time Frame	6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed (N)" signifies participants who evaluable for this measure with a follow up of 6 years post index date. Reporting groups with "N" =0 signifies that no participant had a follow up of 6 years post index date.

Arm/Group Title	Crizotinib + Alectinib + Ceritinib	Crizotinib + Alectinib + Lorlatinib	Crizotinib + Alectinib + Brigatinib	Crizotinib + Ceritinib + Alectinib	Crizotinib + Ceritinib + Lorlatinib	Crizotinib + Ceritinib + Brigatinib	Crizotinib + Brigatinib + Alectinib	Crizotinib + Brigatinib + Lorlatinib	Alectinib + Brigatinib + Lorlatinib	Alectinib + Lorlatinib + Brigatinib	Alectinib + Lorlatinib + Ceritinib	Ceritinib + Alectinib + Lorlatinib	Ceritinib + Alectinib + Brigatinib	Crizotinib + Alectinib + Ceritinib + Chemotherapy	Crizotinib + Alectinib + Lorlatinib + Chemotherapy	Crizotinib + Alectinib + Brigatinib + Chemotherapy	Crizotinib + Ceritinib + Alectinib + Chemotherapy	Crizotinib + Ceritinib + Lorlatinib + Chemotherapy	Crizotinib + Ceritinib + Brigatinib + Chemotherapy	Crizotinib + Brigatinib + Alectinib + Chemotherapy	Crizotinib + Brigatinib + Lorlatinib + Chemotherapy	Alectinib + Brigatinib + Lorlatinib + Chemotherapy	Alectinib + Lorlatinib + Brigatinib + Chemotherapy	Alectinib + Lorlatinib + Ceritinib + Chemotherapy	Ceritinib + Alectinib + Lorlatinib + Chemotherapy	Ceritinib + Alectinib + Brigatinib + Chemotherapy
Arm/Group Description	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and ceritinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment and alectinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment and alectinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment and ceritinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and lorlatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment and brigatinib as third line ALK TKI treatment, in real world practices.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, ceritinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment, alectinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, ceritinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment, alectinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received crizotinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK TKI treatment, brigatinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received alectinib as first line ALK TKI treatment, lorlatinib as second line ALK TKI treatment, ceritinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, lorlatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.	Participants included in this arm received ceritinib as first line ALK TKI treatment, alectinib as second line ALK TKI treatment, brigatinib as third line ALK TKI treatment, in real world practices along with chemotherapy.
Measure Participants	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0
Number [Percentage of participants]	0.00 0%

27. Primary Outcome

Title	Percentage of Participants Alive After 6 Years From Index Date: Based on ALK Sequencing, More Than or Equal to (>=) 4 Lines of ALK TKI Treatment
Description	Participants alive after six years from index date (date of first ALK TKI prescription) to the date of death due to any cause or censoring date (latest available date in data), were reported. In this outcome measure, data is reported for participants who received >=4 lines of ALK inhibitor treatment with or without chemotherapy.
Time Frame	6 years post index date during data identification period of 9 years (retrieved data assessed in this observational study for approximately 3 months)

Outcome Measure Data

Analysis Population Description

Analysis population included all eligible participants whose data were retrieved from Swedish administrative registers and assessed. Here, "Overall Number of Participants Analyzed" signifies participants who were evaluable for this outcome measure with a follow up of 6 years post index date.

Arm/Group Title	>=4 Lines of ALK TKI	>=4 Lines of ALK TKI With Chemotherapy
Arm/Group Description	Participants included in this arm received at least 4 different ALK TKIs, in real world practices.	Participants included in this arm received at least 4 different ALK TKIs, in real world practices along with chemotherapy.
Measure Participants	1	3
Number [Percentage of participants]	0.00 0%	33.33 16.3%

Adverse Events

Time Frame	Not applicable as adverse events not collected during the study
Adverse Event Reporting Description	Due to non-interventional nature of study, the minimum criteria for reporting an adverse event (i.e., identifiable participant, identifiable reporter, a suspect product, and event) could not be met; hence, adverse events were not collected and reported.
Arm/Group Title	Participants With No First Line Chemotherapy		Participants With First Line Chemotherapy
Arm/Group Description	Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, with no first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.		Participants included in this arm received at least one filled prescription of ALK TKIs in real world practices, along with first line chemotherapy treatment. ALK TKIs were crizotinib, alectinib, brigatinib, ceritinib, or lorlatinib.
All Cause Mortality
	Participants With No First Line Chemotherapy		Participants With First Line Chemotherapy
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)
Serious Adverse Events
	Participants With No First Line Chemotherapy		Participants With First Line Chemotherapy
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)
Other (Not Including Serious) Adverse Events
	Participants With No First Line Chemotherapy		Participants With First Line Chemotherapy
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)

Limitations/Caveats

Due to ethical compliance study team ensured results would not be reported for those cohorts/groups which had less than 5 participants at the index date.

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

Pfizer has the right to review disclosures, requesting a delay of less than 60 days. Investigator will postpone single center publications until after disclosure of pooled data (all sites), less than 12 months from the study completion/termination at all participating sites. Investigator may not disclose previously undisclosed confidential information other than study results.