Icotinib might be effective for the treatment of leptomeningeal carcinomatosis in non-small cell lung cancer with sensitive EGFR mutations

Gong, Lei; Xiong, Ming; Huang, Zhiyu; Miao, Lulu; Fan, Yun

doi:10.1016/j.lungcan.2015.06.001

Cited by 26 publications

(17 citation statements)

References 23 publications

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“…I n this context, our study of NSCLC patients with LMC who were treated exclusively with WBRT demonstrated the absence of BM as a significant prognosticator for longer median OS (5.8 vs. 3.6 months; p = 0.012). Supporting our results, the study by Gong et al [25] which investigated the efficacy of icotinib in 21 NSCLC patients with LMC, demonstrated a strong trend toward superior OS in the absence of parenchymal BM (11.1 vs. 8.1 months, p = 0.066).…”

Section: Fig 2 Overall Survival In 51 Patientssupporting

confidence: 89%

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Whole brain radiotherapy in management of non-small-cell lung carcinoma associated leptomeningeal carcinomatosis: evaluation of prognostic factors

2016

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To assess the efficacy of whole-brain radiotherapy (WBRT) and prognostic factors in leptomeningeal carcinomatosis (LMC) of non-small-cell lung cancer (NSCLC) patients. WBRT records of 51 LMC patients confined to brain were reviewed. Eligible patients had squamous-cell carcinoma (SCC) or adenocarcinoma, and Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-3. The WBRT was either 20 or 30 Gray. The primary and secondary objectives were to determine overall survival (OS) and prognostic factors for improved treatment response, respectively. Median age was 53 years (range 39-68), 58.8 % had SCC, 74.5 % had ECOG PS 1-2, and 70.6 % had LMC accompanied by parenchymal brain metastases (BM). The median follow-up was 4.1 months (range 0.7-14.4); all patients died due to disease progression. Median OS was 3.9 months (95 % CI 3.3-4.5) with 6 and 12 month estimates of 19.6 and 5.9 %, respectively. Evaluation of prognostic factors revealed that patients with ECOG 1, longer time to LMC (TT-LMC) from NSCLC diagnosis (>11.3 months), and absence of parenchymal BM had significantly superior OS than those patients with ECOG 2 (p = 0.01) or 3 (p < 0.001), TT-LMC < 11.3 months (p = 0.001), and parenchymal BM (p = 0.012). Median OS of 3.9 months after WBRT appeared to confirm the poor prognosis of LMC. WBRT might be most effective for patients with favorable PS, longer TT-LMC, and no accompanying BM. Therefore, we identified ECOG PS 1, TT-LMC > 11.3 months, and no BM as independent prognosticators for better response to WBRT in NSCLC patients with LMC.

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Section: Fig 2 Overall Survival In 51 Patientssupporting

confidence: 89%

“…The prognostic impact of parenchymal BM in LMC patients is an area of active research [16,25,26]. Particular to LMC of NSCLC, parenchymal BM is present in more than 50 % of cases.…”

Section: Fig 2 Overall Survival In 51 Patientsmentioning

confidence: 99%

Whole brain radiotherapy in management of non-small-cell lung carcinoma associated leptomeningeal carcinomatosis: evaluation of prognostic factors

2016

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“…The authors hypothesized that EGFR could regulate DNA repair dynamics and that NSCLCharboring patients with the EGFR mutation might be more sensitive to radiotherapy than those with wild-type EGFR. Consistent with our study, the retrospective study of Gong et al (28) showed that those patients with leptomeningeal metastasis from EGFR-mutated NSCLC who were treated with icotinib had a median OS time of 10.1 months. Those patients with exon 19 deletion demonstrated a longer CPFS than those who harbored exon 21 L858R after the treatment with icotinib plus WBRT.…”

Section: Discussionsupporting

confidence: 92%

Icotinib combined whole brain radiotherapy for patients with brain metastasis from lung adenocarcinoma harboring epidermal growth factor receptor mutation

Zhang

2016

J. Thorac. Dis.

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Background: The brain is a metastatic organ that is most prone to lung adenocarcinoma (LAC). However, the prognosis of patients with brain metastasis remains very poor. In this study, we evaluated the efficacy of icotinib plus whole brain radiation therapy (WBRT) for treating patients with brain metastasis from epidermal growth factor receptor (EGFR)-mutated LAC. Methods: All patients received standard WBRT administered to the whole brain in 30 Gy in 10 daily fractions. Each patient was also instructed to take 125 mg icotinib thrice per day beginning from the first day of the WBRT. After completing the WBRT, maintenance icotinib was administered until the disease progressed or intolerable adverse effects were observed. Cranial progression-free survival (CPFS) and overall survival (OS) times were the primary endpoints. Results: A total of 43 patients were enrolled in this study. Two patients (4.7%) presented a complete response (CR), whereas 20 patients (46.5%) presented a partial response (PR). The median CPFS and OS times were 11.0 and 15.0 months, respectively. The one-year CPFS rate was 40.0% for the patients harboring EGFR exon 19 deletion and 16.7% for the patients with EGFR exon 21 L858R (P=0.027). Conclusions: The concurrent administration of icotinib and WBRT exhibited favorable effects on the patients with brain metastasis. EGFR exon 19 deletion was predictive of a long CPFS following icotinib plus WBRT.

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“…LM usually occur during TKI therapy; high-dose TKIs and switching TKIs have been recommended in small series studies. [16][17][18][19][20][21] Patients with LM usually have poor performance status and most of them fail to accept systematic chemotherapy. Regarding WBRT, its role remains controversial; some authors claimed that it predicts favorable survival, but others disagreed, and research on WBRT alone in LM with EGFR mutations is lacking.…”

Section: Introductionmentioning

confidence: 99%

Leptomeningeal Metastases in Patients with NSCLC with EGFR Mutations

Jiang

Yang

et al. 2016

Journal of Thoracic Oncology

227

196

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Icotinib might be effective for the treatment of leptomeningeal carcinomatosis in non-small cell lung cancer with sensitive EGFR mutations

Cited by 26 publications

References 23 publications

Whole brain radiotherapy in management of non-small-cell lung carcinoma associated leptomeningeal carcinomatosis: evaluation of prognostic factors

Whole brain radiotherapy in management of non-small-cell lung carcinoma associated leptomeningeal carcinomatosis: evaluation of prognostic factors

Icotinib combined whole brain radiotherapy for patients with brain metastasis from lung adenocarcinoma harboring epidermal growth factor receptor mutation

Leptomeningeal Metastases in Patients with NSCLC with EGFR Mutations

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