Upfront thoracic radiotherapy to primary lession improve outcomes in patients with stage IV non-small cell lung cancer harboring EGFR mutations.

Abstract

e21167 Background: The role of thoracic radiotherapy in the treatment of metastatic EGFR mutant non-small cell lung cancer patients in literature datas are insufficient.The aim of this study was to examine the effectiveness of upfront thoracic radiotherapy in metastatic EGFR mutant NSCLC patients treated with chemotherapy or TKI. Methods: This study was designed as a hospital-based retrospective observational case-series study. A total of 141 patients with metastatic EGFR mutant non-small cell lung cancer who has followed in two different oncology centers at Turkey between 2014 and 2020. have been included to this study. Results: The median age of the patients was 63 (range 35-91) years. EGFR mutation results of exon 19 deletion, exon 21 mutation and exon 18 mutation were found in 82 (58.2%), 56 (39.7%) and 3 (2.1%) patients, respectively. The median follow-up time was 22 months and 94 (33.3%) patients died during follow-up. Median overall survival (OS) was 26 months and progression free survival (for first line treatment) (PFS) was 10 months for whole patients, respectively. Radiotherapy was given to the primary tumor site in 32 (22,6%) patients. Patients receiving radiotherapy to primary tumor site had better overall survival than those not (31 versus 23 months respectively and p = 0,02) The survival advantage was also seen for patients group taking TKI at upfront setting (33 versus 23 months respectively and p = 0.05). Conclusions: In this study, we have showed that upfront thoracic radiotherapy to primary lession as combination with EGFR-TKI treatment may improve the outcome in advanced stage IV NSCLC patients harboring EGFR mutations.

Recent advances progress of targeted drugs combined with radiotherapy for advanced non-small cell lung cancer: a review

“…The median time to progression (TTP) of radiation disease is 20.5 months; ORR is 50%; disease control rate (DCR) is 100%; and toxicity is acceptable (10% of patients develop rash; 20% of patients develop radiation pneumonia) (20). A retrospective study reached similar conclusions and also found that patients receiving stereotactic body radiation therapy (SBRT) had better OS compared to threedimensional conformal radiotherapy (46 months vs 26 months, P=0.05) (21). A prospective phase II Randomized controlled trial (NCT03595644) using SBRT combined with EGFR-TKI found that compared with EGFR-TKI alone, it prolonged the PFS (17.6 months vs 9.0 months, HR=0.52, P=0.016) and OS (33.6 months vs 23.2 months, HR=0.53, P=0.026) of patients, and reduced the incidence of grade 2 AE (45.2% vs 50%).…”

Survival benefit of thoracic radiotherapy plus EGFR-TKIs in patients with non-oligometastatic advanced non-small-cell lung cancer: a single-center retrospective study

“… 15 , 30 , 31 Moreover, several studies have examined the activity of thoracic radiation in advanced NSCLC patients harboring TKI-sensitive EGFR mutations. 22 , 23 , 32 , 33 Zheng et al conducted a prospective study to assess the efficacy of thoracic radiotherapy in combination with EGFR-TKIs on stage IV EGFR mutant lung adenocarcinomas. 22 A superior 1-year PFS was observed in the combination therapy group.…”

“…Currently, limited studies address the efficacy and safety of adding thoracic radiotherapy to EGFR-TKIs as the first-line treatment for metastatic NSCLC patients with EGFR-sensitizing mutations. 22,23 In a recent prospective study involving 10 advanced NSCLC patients, Zheng et al reported that the concurrent EGFR-TKIs combined with thoracic radiotherapy achieve significant control for the primary lung lesions. 22 The data still need to be confirmed in a larger sample study.…”