Effect of EGFR-TKIs combined with craniocerebral radiotherapy on the prognosis of EGFR-mutant lung adenocarcinoma patients with brain metastasis: A propensity-score matched analysis

Abstract

Background and PurposeEpidermal growth factor receptor (EGFR)-mutant lung cancers are associated with a high risk of developing brain metastases (BM). Craniocerebral radiotherapy is a cornerstone for the treatment of BM, and EGFR-TKIs act on craniocerebral metastases”. However, whether EGFR-TKIs combined with craniocerebral radiotherapy can further increase the efficacy and improve the prognosis of patients is unclear. This study aimed to evaluate the difference in efficacy between targeted-therapy alone and targeted-therapy combined with radiotherapy in EGFR-mutant lung adenocarcinoma patients with BM.Materials and MethodsA total of 291 patients with advanced non-small cell lung cancer (NSCLC) and EGFR mutations were enrolled in this retrospective cohort study. Propensity score matching (PSM) was conducted using a nearest-neighbor algorithm (1:1) to adjust for demographic and clinical covariates. Patients were divided into two groups: EGFR-TKIs alone and EGFR-TKIs combined with craniocerebral radiotherapy. Intracranial progression-free survival (iPFS) and overall survival (OS) were calculated. Kaplan–Meier analysis was used to compare iPFS and OS between the two groups. Brain radiotherapy included WBRT, local radiotherapy, and WBRT+Boost.ResultsThe median age at diagnosis was 54 years (range: 28–81 years). Most patients were female (55.9%) and non-smokers (75.5%). Fifty-one pairs of patients were matched using PSM. The median iPFS for EGFR-TKIs alone (n=37) and EGFR-TKIs+craniocerebral radiotherapy (n=24) was 8.9 and 14.7 months, respectively. The median OS for EGFR-TKIs alone (n=52) and EGFR-TKIs+craniocerebral radiotherapy (n=52) was 32.1 and 45.3 months, respectively.ConclusionIn EGFR-mutant lung adenocarcinoma patients with BM, targeted therapy combined with craniocerebral radiotherapy is an optimal treatment.

The Effect of Intracranial Control After Intracranial Local Therapy on the Prognosis of Patients with Brain Metastasis of Lung Adenocarcinoma

“…Deng et al draw a similar conclusion that prolonged iPFS translates into a better OS in EGFR-mutant lung adenocarcinoma patients with BM who received TKIs combined with craniocerebral radiotherapy. 29 In contrast to our findings, another study by Deng et al showed that in low scores of Lung-molGPA patients with EGFR-mutant lung adenocarcinoma with BMs, the enhanced iPFS failed to translate to improved OS among three brain radiotherapy modes. 30 Given the correlation between iPFS and OS after intracranial local therapy for BMs of lung adenocarcinoma patients is controversial, and there are fewer relevant reports, the findings of the current study can contribute to the data in the literature database.…”

Bevacizumab improved prognosis for advanced EGFR-mutant lung adenocarcinoma with brain metastasis receiving cerebral radiotherapy

“…It is one of the main tools for increasing local control in patients with EGFR-mutant NSCLC BMs [6, 25,26]. In a previous study we showed that EGFR-TKIs combined with craniocerebral radiotherapy improved iPFS, OS, and PFS in patients with EGFR-mutant lung adenocarcinoma with BM [27]. The current study further explored whether the combined use of bevacizumab could lead to survival bene ts in patients with EGFR-mutant NSCLC BMs undergoing cerebral radiotherapy.…”

Bevacizumab improved prognosis for advanced EGFR-mutant lung adenocarcinoma with brain metastasis receiving cerebral radiotherapy

“…It is one of the main tools for increasing local control in patients with EGFR-mutant NSCLC-BM [ 6 , 25 , 26 ]. In a previous study, we showed that EGFR-TKI combined with craniocerebral radiotherapy improved iPFS, OS and PFS in patients with EGFR-mutant lung adenocarcinoma with BM [ 27 ]. The current study further explored whether the combined use of bevacizumab could lead to survival benefits in patients with EGFR-mutant NSCLC-BM undergoing cerebral radiotherapy.…”