2021
DOI: 10.3389/fonc.2021.739765
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Comparative Efficacy of Systemic Agents for Brain Metastases From Non-Small-Cell Lung Cancer With an EGFR Mutation/ALK Rearrangement: A Systematic Review and Network Meta-Analysis

Abstract: BackgroundBrain metastases (BM) from non-small-cell lung cancer (NSCLC) are frequent and carry significant morbidity, and current management options include varying local and systemic therapies. Here, we performed a systematic review and network meta-analysis to determine the ideal treatment regimen for NSCLC BMs with targetable EGFR-mutations/ALK-rearrangements.MethodsWe searched MEDLINE, EMBASE, Web of Science, ClinicalTrials.gov, CENTRAL and references of key studies for randomized controlled trials (RCTs) … Show more

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Cited by 8 publications
(4 citation statements)
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“…The most common mechanism of acquired resistance is EGFR T790M mutation, which affects the use of first-and second-generation EGFR-TKIs [13], while third-generation EGFR-TKIs, such as osimertinib, have good efficacy in T790M positive patients [16,17]. In addition, third-generation EGFR-TKIs can exert better therapeutic effects on the central nervous system (CNS) [18][19][20], but the occurrence of EGFR-TKI-related ILD limits long-term use [13,20,21]. At present, the mechanism of EGFR-TKI-related ILD is not clear.…”
Section: Discussionmentioning
confidence: 99%
“…The most common mechanism of acquired resistance is EGFR T790M mutation, which affects the use of first-and second-generation EGFR-TKIs [13], while third-generation EGFR-TKIs, such as osimertinib, have good efficacy in T790M positive patients [16,17]. In addition, third-generation EGFR-TKIs can exert better therapeutic effects on the central nervous system (CNS) [18][19][20], but the occurrence of EGFR-TKI-related ILD limits long-term use [13,20,21]. At present, the mechanism of EGFR-TKI-related ILD is not clear.…”
Section: Discussionmentioning
confidence: 99%
“…Approximately 50–60% of patients with the EGFR mutant or ALK fusion-positive NSCLC develop brain metastases during the course of their disease [ 4 , 5 , 6 ] and this may increase as extracranial disease control improves with better systemic therapy [ 3 , 7 , 8 ]. Systemic therapy agents have variable intracranial penetrance [ 9 , 10 , 11 ] or are effective for a limited time and local treatment with surgical resection and/or radiation is often required [ 12 , 13 ]. Stereotactic radiosurgery (SRS) has become the standard of care for patients with a limited volume of intracranial disease not suitable for surgical resection, delivering high-dose radiation in a single or few fractions, with rapid dose fall-off outside the target, and improving survival with lower toxicity compared with whole-brain radiotherapy (WBRT) [ 14 , 15 , 16 ].…”
Section: Introductionmentioning
confidence: 99%
“…The development of novel therapeutic strategies has remarkably enhanced the survival outcomes of patients with LUAD. [ 7–11 ] Immune checkpoint inhibitors (ICIs) targeting programmed cell death 1/ligand 1 (PD‐1/PD‐L1) can induce an effective antitumor role in these patients. [ 12,13 ] However, not all patients respond to ICIs, and their overall survival (OS) outcomes necessitate further improvement.…”
Section: Introductionmentioning
confidence: 99%