Upfront Cranial Radiotherapy Followed by Erlotinib Positively Affects Clinical Outcomes of Epidermal Growth Factor Receptor-mutant Non-small Cell Lung Cancer With Brain Metastases

Abstract

Background/Aim: The optimal treatment strategy for epidermal growth factor receptor (EGFR)-mutant nonsmall cell lung cancer (NSCLC) patients with brain metastasis (BM) has not yet been fully determined. The aim of this study was to investigate the optimal management of EGFR-mutant NSCLC patients with BM. Patients and Methods: A multicenter retrospective study was performed on the clinical outcomes of 81 advanced/recurrent EGFR-mutant NSCLC patients with BM treated with EGFR-tyrosine kinase inhibitors (EGFR-TKIs) (gefitinib n=52 or erlotinib n=29). Results: Among the 81 patients, 30 patients received upfront cranial radiotherapy (CRT) and 51 did not. The multivariate cox analyses revealed that the use of erlotinib and upfront CRT were independent predictive factors for overall survival (OS) (erlotinib: HR 0.21; 95% CI, p<0.001; upfront CRT: HR 0.42; 95% CI, p=0.022). Conclusion: Erlotinib and upfront CRT were associated with a favorable prognosis among EGFR-mutant NSCLC patients with BM. Upfront CRT followed by erlotinib may be an appropriate initial management approach for EGFR-mutant NSCLC patients with BM.

The Efficacy of EGFR-Tyrosine Kinase Inhibitor in Non-Small Cell Lung Cancer Patients With Synchronous Brain Metastasis: A Real-World Study

“…However, direct comparison with the current study seems to be di cult because some of these ones analyzed patient cohorts treated with WBRT alone [18] or including second or further line of EGFR-TKI therapy [8,19]. Upfront EGFR-TKI may be a useful option for certain subgroups of EGFR-mutant NSCLC patients with BM such as those having no CNS symptom or a smaller number of BM lesions, given its antitumor activity in BM in addition to extracranial lesions [5,7,20]. Furthermore, the initiation of systemic treatment is not delayed with the avoidance of potential toxicity of local treatment [1].…”

“…The most controversial issue in the management of EGFR-mutant NSCLC with BM is the incorporation of local treatment. Although many retrospective studies showed con icting results [5][6][7][8][15][16][17][18][19][20], a few meta-analyses revealed better OS by addition of local treatment [2,21,22]. Furthermore, a large retrospective study from the United States demonstrated improved OS using upfront local treatment compared with EGFR-TKI alone [1].…”

“…Approximately 20-40% of non-small cell lung cancer (NSCLC) patients will develop brain metastasis (BM) during the course of their disease [1,2]. In several studies especially from Asia, the frequency of synchronous or metachronous BM in epidermal growth factor receptor (EGFR)-mutant NSCLC patients (39-70%) has been higher than that in patients with the EGFR-wild type (28-38%) [3][4][5]. Before the development of targeted therapy, the median overall survival (OS) of an unselected population of NSCLC patients with BM including EGFR-mutant was generally poor, ranging from 3 to 15 months [1,2].…”

Upfront Brain Radiotherapy Improves Intracranial Progression-Free Survival but not Overall Survival in Lung Adenocarcinoma Patients with Brain Metastases: A Retrospective Single-Institutional Analysis from China

“…However, the retrospective study by Magnuson et al [21] demonstrated inferior OS with deferral of brain radiotherapy. Upfront BRT followed by TKI may be an appropriate initial management approach for EGFR-mutant NSCLC patients with BM [22] .…”

Upfront brain radiotherapy improves intracranial progression-free survival but not overall survival in lung adenocarcinoma patients with brain metastases: a retrospective, single-institutional analysis from China

“…However, the retrospective study by Magnuson et al [ [21] ] demonstrated inferior OS with deferral of BRT. Another study reported that upfront BRT followed by TKI therapy may be an appropriate initial management approach for EGFR-mutant NSCLC patients with BM [ [22] ] .…”