EGFR tyrosine kinase inhibitors versus cranial radiation therapy for EGFR mutant non-small cell lung cancer with brain metastases: A systematic review and meta-analysis

Soon, Yu Yang; Leong, Cheng Nang; Koh, Winston T. H.; Tham, Ivan

doi:10.1016/j.radonc.2014.12.011

Cited by 104 publications

(81 citation statements)

References 37 publications

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“…An alternative strategy is the use of cranial radiotherapy (SRS or WBRT) in combination with TKIs, which may improve PFS and OS compared with TKIs alone or radiotherapy with or without chemotherapy, although this is somewhat controversial and remains to be proven (class IIIa and b). 73,74 A phase II study from China has reported that the combination of WBRT and erlotinib has tolerable toxicities, and suggested a prolonged PFS and OS (class IIb). 75 Conversely, phase II (class IIa and b) 76,77 and phase III (class I) 78 trials in patients with NSCLC brain metastases not enriched for EGFR mutations failed to demonstrate a superiority of the combination of erlotinib with either SRS or WBRT over radiotherapy alone, with a suggestion of worse outcome in patients receiving the combined therapy.…”

Section: Brain Metastases From Nsclcmentioning

confidence: 99%

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Soffietti

Abacıoğlu²,

Baumert³

et al. 2017

Neuro-Oncology

422

338

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The management of patients with brain metastases has become a major issue due to the increasing frequency and complexity of the diagnostic and therapeutic approaches. In 2014, the European Association of NeuroOncology (EANO) created a multidisciplinary Task Force to draw evidence-based guidelines for patients with brain metastases from solid tumors. Here, we present these guidelines, which provide a consensus review of evidence and recommendations for diagnosis by neuroimaging and neuropathology, staging, prognostic factors, and different treatment options. Specifically, we addressed options such as surgery, stereotactic radiosurgery/stereotactic fractionated radiotherapy, whole-brain radiotherapy, chemotherapy and targeted therapy (with particular attention to brain metastases from non-small cell lung cancer, melanoma and breast and renal cancer), and supportive care. Key wordsbrain metastases | chemotherapy | neuroimaging | neuropathology | stereotactic radiosurgery/stereotactic fractionated radiotherapy | supportive care | surgery | targeted therapy | whole-brain radiation therapy

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Section: Brain Metastases From Nsclcmentioning

confidence: 99%

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Soffietti

Abacıoğlu²,

Baumert³

et al. 2017

Neuro-Oncology

422

338

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“…However, in patients with driver mutations, whether EGFR-TKIs can enhance or replace cranial irradiation in the initial treatment of BM remains unclear. In a recent meta-analysis, upfront radiation therapy was shown to improve intracranial disease control and survival compared to TKI monotherapy in patients with EGFR mutant tumors (65). In this meta-analysis, a small proportion of patients received a combination of WBRT and EGFR TKI.…”

Section: Rationale and Clinical Datamentioning

confidence: 99%

Non-small cell lung cancer (NSCLC) and central nervous system (CNS) metastases: role of tyrosine kinase inhibitors (TKIs) and evidence in favor or against their use with concurrent cranial radiotherapy

Economopoulou¹,

Mountzios²

2016

Transl. Lung Cancer Res.

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Central nervous system (CNS) metastases, including brain metastases (BM) and leptomeningeal metastases (LM) represent a frequent complication of non-small cell lung cancer (NSCLC). Patients with BM comprise a heterogeneous group, with a median survival that ranges from 3 to 14 months. However, in the majority of patients, the occurrence of CNS metastases is usually accompanied by severe morbidity and substantial deterioration in quality of life. Local therapies, such as whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) or surgical resection, either alone or as part of a multimodality treatment are available treatment strategies for BM and the choice of therapy varies depending on patient group and prognosis. Meanwhile, introduction of tyrosine kinase inhibitors (TKIs) in clinical practice has led to individualization of therapy based upon the presence of the exact abnormality, resulting in a major therapeutic improvement in patients with NSCLC who harbor epidermal growth factor receptor (EGFR) activating mutations or anaplastic lymphoma kinase (ALK) gene rearrangements, respectively. Based on their clinical activity in systemic disease, such molecular agents could offer the promise of improved BM control without substantial toxicity; however, their role in combination with radiotherapy is controversial. In this review, we discuss the controversy regarding the use of TKIs in combination with radiotherapy and illustrate future perspectives in the treatment of BM in NSCLC.

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“…Recently Soon et al (107), in a systematic review and meta-analysis of 12 prospective and retrospective studies, compared the effects of brain radiotherapy vs. TKIs alone on intracranial disease, in EGFR mutated NSCLC with BM. In contrast with previous data, this meta-analysis showed an advantage in the 2-year OS for the upfront cranial radiotherapy, either WBRT or SRS, compared with TKIs alone (WBRT: 60%, SRS: 93%, TKIs alone: 45%).…”

Section: Standard Schedulesmentioning

confidence: 99%

Epidermal growth factor receptor tyrosine kinase inhibitors for the treatment of central nervous system metastases from non-small cell lung cancer: the present and the future

Proto¹,

Imbimbo²,

Gallucci³

et al. 2016

Transl. Lung Cancer Res.

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EGFR tyrosine kinase inhibitors versus cranial radiation therapy for EGFR mutant non-small cell lung cancer with brain metastases: A systematic review and meta-analysis

Cited by 104 publications

References 37 publications

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Non-small cell lung cancer (NSCLC) and central nervous system (CNS) metastases: role of tyrosine kinase inhibitors (TKIs) and evidence in favor or against their use with concurrent cranial radiotherapy

Epidermal growth factor receptor tyrosine kinase inhibitors for the treatment of central nervous system metastases from non-small cell lung cancer: the present and the future

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